联合检测肿瘤标志物用于胆囊癌的诊断和预后评估。
Combined detection tumor markers for diagnosis and prognosis of gallbladder cancer.
作者信息
Wang Yun-Feng, Feng Fei-Ling, Zhao Xu-Hong, Ye Zhen-Xiong, Zeng He-Ping, Li Zhen, Jiang Xiao-Qing, Peng Zhi-Hai
机构信息
Yun-Feng Wang, Zhi-Hai Peng, Department of Hepatobiliary Surgery, Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong Province, China.
出版信息
World J Gastroenterol. 2014 Apr 14;20(14):4085-92. doi: 10.3748/wjg.v20.i14.4085.
AIM
To clarify the value of combined use of markers for the diagnosis of gallbladder cancer and prediction of its prognosis.
METHODS
Serum cancer antigens (CA)199, CA242, carcinoembryonic antigen (CEA), and CA125 levels were measured in 78 patients with gallbladder cancer (GBC), 78 patients with benign gallbladder diseases, and 78 healthy controls using electrochemiluminescence. CA199, CA242, CEA, and CA125 levels and positive rates were analyzed and evaluated pre- and post-operatively. Receiver operator characteristic curves were used to determine diagnostic sensitivity and specificity of GBC. Survival time analysis, including survival curves, and multivariate survival analysis of a Cox proportional hazards model was performed to evaluate independent prognostic factors.
RESULTS
Serum CA242, CA125, and CA199 levels in the GBC group were significantly higher when compared with those in the benign gallbladder disease and healthy control groups (P < 0.01). With a single tumor marker for GBC diagnosis, the sensitivity of CA199 was the highest (71.7%), with the highest specificity being in CA242 (98.7%). Diagnostic accuracy was highest with a combination of CA199, CA242, and CA125 (69.2%). CA242 could be regarded as a tumor marker of GBC infiltration in the early stage. The sensitivity of CA199 and CA242 increased with progression of GBC and advanced lymph node metastasis (P < 0.05). The 78 GBC patients were followed up for 6-12 mo (mean: 8 mo), during which time serum CA199, CA125, and CA242 levels in the recurrence group were significantly higher than in patients without recurrence (P < 0.01). The post-operative serum CA199, CA125, and CA242 levels in the non-recurrence group were significantly lower than those in the GBC group (P < 0.01). Multivariate survival analysis using a Cox proportional hazards model showed that cancer of the gallbladder neck and CA199 expression level were independent prognostic factors.
CONCLUSION
CA242 is a marker of GBC infiltration in the early stage. CA199 and cancer of the gallbladder neck are therapeutic and prognostic markers.
目的
阐明联合使用标志物对胆囊癌诊断及预后预测的价值。
方法
采用电化学发光法检测78例胆囊癌（GBC）患者、78例良性胆囊疾病患者及78例健康对照者血清癌抗原（CA）199、CA242、癌胚抗原（CEA）和CA125水平。分析评估术前及术后CA199、CA242、CEA和CA125水平及阳性率。采用受试者工作特征曲线确定GBC的诊断敏感性和特异性。进行生存时间分析，包括生存曲线分析，并采用Cox比例风险模型进行多因素生存分析以评估独立预后因素。
结果
GBC组血清CA242、CA125和CA199水平显著高于良性胆囊疾病组和健康对照组（P<0.01）。单一肿瘤标志物诊断GBC时，CA199敏感性最高（71.7%），CA242特异性最高（98.7%）。CA199、CA242和CA125联合诊断准确性最高（69.2%）。CA242可视为GBC早期浸润的肿瘤标志物。CA199和CA242的敏感性随GBC进展及淋巴结转移情况增加（P<0.05）。78例GBC患者随访6 - 12个月（平均8个月），复发组血清CA199、CA125和CA242水平显著高于未复发患者（P<0.01）。非复发组术后血清CA199、CA125和CA242水平显著低于GBC组（P<0.01）。采用Cox比例风险模型进行多因素生存分析显示，胆囊颈部癌和CA199表达水平是独立预后因素。
结论
CA242是GBC早期浸润的标志物。CA199和胆囊颈部癌是治疗及预后标志物。
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