Hoskovec David, Varga Jozef, Konečná Ellen, Antos Frantisek
Charles University Prague, Czech Republic.
Acta Cir Bras. 2012 Jun;27(6):410-6. doi: 10.1590/s0102-86502012000600009.
Tumor markers are substances found in blood and other biological fluids if tumor is present in the body. They can be produced by tumor itself or can be results of cancer - body relation. They may be used in the follow-up of cancer patients to identify tumor recurrence. Pre-treatment levels have prognostic tool and could signalize persistence of minimal residual disease despite radical surgery.
We operated on 52 patients with upper GI malignancy (32 with gastric cancer and 20 with pancreatic cancer). Blood samples were taken before surgery and peritoneal samples immediately after laparotomy before any manipulation with tumor. All samples were examined by standard biochemical technique and the level was compared with a stage of the disease.
Patients suffering from gastric carcinoma of stage I and II had higher level of both markers in sera then in the peritoneal cavity, however most of them were within physiological range. Patients in stage III and IV had average marker levels in the peritoneal cavity higher than in sera. Number of positive findings was increasing according to the stage of the disease. The peritoneal levels of both markers varied extremely in higher stages. In patients suffering from pancreatic carcinoma the CEA levels both in sera and peritoneal cavity were parallel but peritoneal levels were slightly higher in stages III and IV. Ca 19 - 9 was more sensitive for pancreatic cancer. The percentage of positive findings was higher in sera but the level of Ca 19 - 9 was higher in the peritoneal cavity. The number of positive findings again correlated with the stage of the disease.
Levels of tumor markers in sera could signalize inoperability of tumor (Ca 19 - 9 in cases of pancreatic carcinoma); peritoneal levels could predict R1 resection especially in gastric cancer patients and risk of early peritoneal recurrence of the disease. Difference between the levels in the peritoneum and sera may signalize the route of dissemination (hematogenous and intraperitoneal).
肿瘤标志物是在体内存在肿瘤时于血液和其他生物体液中发现的物质。它们可由肿瘤自身产生，也可为癌症与机体相互作用的结果。它们可用于癌症患者的随访以识别肿瘤复发。治疗前水平具有预后评估作用，并且可提示尽管进行了根治性手术但仍存在微小残留疾病。
我们对52例上消化道恶性肿瘤患者（32例胃癌患者和20例胰腺癌患者）进行了手术。术前采集血样，剖腹手术后在对肿瘤进行任何操作之前立即采集腹腔样本。所有样本均采用标准生化技术进行检测，并将检测水平与疾病分期进行比较。
Ⅰ期和Ⅱ期胃癌患者血清中两种标志物的水平均高于腹腔内水平，不过大多数都在生理范围内。Ⅲ期和Ⅳ期患者腹腔内标志物平均水平高于血清。阳性发现的数量随疾病分期增加。在较高分期中，两种标志物的腹腔内水平差异极大。胰腺癌患者血清和腹腔内的癌胚抗原（CEA）水平呈平行关系，但在Ⅲ期和Ⅳ期腹腔内水平略高。糖类抗原19 - 9（Ca 19 - 9）对胰腺癌更敏感。血清中阳性发现的百分比更高，但Ca 19 - 9在腹腔内的水平更高。阳性发现的数量再次与疾病分期相关。
血清中肿瘤标志物水平可提示肿瘤无法切除（胰腺癌病例中的Ca 19 - 9）；腹腔内水平可预测R1切除，尤其是在胃癌患者中，以及疾病早期腹腔复发的风险。腹膜和血清中水平的差异可提示播散途径（血行性和腹腔内）。
