Laboratory of Surgical Research, Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Int J Colorectal Dis. 2013 Jun;28(6):767-75. doi: 10.1007/s00384-012-1625-1. Epub 2013 Jan 8.
Presently, no markers exist to predict metachronous metastasis at the time a primary colorectal cancer is diagnosed. While aneuploidy indicates poor survival prognosis and elevated carcinoembryonic antigen (CEA) levels the presence of recurrent disease, the predictive value of both markers regarding imminent metachronous metastases is unclear.
Sixty patients with distant recurrence throughout a 5-year follow-up (TM+) were randomly chosen and 60 patients without metastasis matched to this cohort (TM-). In addition, an enlarged collective (n = 217; n TM+ = 85, n TM- = 132) with median follow-up of 79.2 months was assessed by logistic regression regarding metachronous metastases. Univariate and stepwise regression analyses included clinicopathological characteristics, preoperative CEA levels and aneuploidy assessed by DNA image cytometry.
The matched-pair collective showed aneuploidy in 71.1 % (TM-) and 85.0 % (TM+; p = 0.076), and elevated CEA in 24.5 % (TM-) and 52.2 % [TM+; odds ratio (OR), 3.414; p = 0.007]. The enlarged collective presented aneuploidy in 71.2 % (TM-) and 83.5 % (TM+; OR 2.050, p = 0.038), and elevated CEA in 28.6 % (TM-) and 48.9 % (TM+; OR 2.391, p = 0.020). Elevated CEA and aneuploidy did not show any association (p = 0.919). In contrast, logistic regression analyses demonstrated that besides increased T category (OR 1.745, p = 0.019), both elevated CEA level (OR 2.633, p = 0.015) and aneuploidy (OR 1.929, p = 0.058) were independent predictive markers for metachronous metastasis.
Our data show that aneuploidy and elevated CEA levels besides increased T category could serve for individual risk assessment to predict metachronous metastases. The fact that still aneuploidy missed the significance level by a small margin emphasizes the need for larger validation studies.
目前，在诊断原发性结直肠癌时，尚无预测异时性转移的标志物。虽然非整倍体表示预后不良和癌胚抗原（CEA）水平升高，但存在复发性疾病，这两个标志物对即将发生的异时性转移的预测价值尚不清楚。
在 5 年的随访期间（TM+），随机选择了 60 名远处复发的患者（TM+），并与该队列中的 60 名无转移的患者（TM-）相匹配。此外，对一个扩大的患者队列（n=217；nTM+=85，nTM-=132）进行了中位随访 79.2 个月的逻辑回归分析，以评估异时性转移。单变量和逐步回归分析包括临床病理特征、术前 CEA 水平和通过 DNA 图像细胞术评估的非整倍体。
配对患者队列中，TM-患者的非整倍体率为 71.1%（TM-）和 85.0%（TM+；p=0.076），TM-患者的 CEA 升高率为 24.5%（TM-）和 52.2%（TM+；比值比[OR]，3.414；p=0.007）。在扩大的患者队列中，TM-患者的非整倍体率为 71.2%（TM-）和 83.5%（TM+；OR 2.050，p=0.038），TM-患者的 CEA 升高率为 28.6%（TM-）和 48.9%（TM+；OR 2.391，p=0.020）。CEA 升高和非整倍体之间没有任何关联（p=0.919）。相反，逻辑回归分析表明，除了 T 分期增加（OR 1.745，p=0.019）外，CEA 水平升高（OR 2.633，p=0.015）和非整倍体（OR 1.929，p=0.058）也是异时性转移的独立预测标志物。
我们的数据表明，非整倍体和 CEA 水平升高，除了 T 分期增加外，还可用于个体风险评估，以预测异时性转移。事实上，非整倍体仍然以较小的差距错过了显著水平，这强调了需要更大的验证研究。
