癌胚抗原水平极度升高的结肠癌患者的临床特征与预后

[Clinical characteristics and prognosis of colon cancer patient with extremely elevated carcinoembryonic antigen level].

作者信息

Chen Pengju, Yao Yunfeng, Zhang Dakui, Gu Jin

机构信息

Key laboratory of Carcinogenesis and Translational Research(Ministry of Education), Department of Colorectal Cancer Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2015 Oct;18(10):1026-31.

PMID:26499150

Abstract

OBJECTIVE

To explore the clinicopathological characteristics and prognosis of colon cancer patients with extremely elevated serum carcinoembryonic antigen(CEA) level before operation(>50 μg/L).

METHODS

Clinicopathological and follow-up data of 1250 patients with colonic adenocarcinoma undergoing primary tumor resection between January 2001 and December 2011 were retrospectively analyzed. All the patients were divided into three groups according to the preoperative serum CEA levels as normal group (0-5 μg/L, 721 cases), elevated group(5-50 μg/L, 408 cases) and extremely elevated(>50 μg/L, 121 cases). Kaplan-Meier method was used to analyze the overall survival and disease-free survival. Log-rank test was used to compare the survival between groups. Cox regression was used to screen the independent prognostic factors of colon cancer.

RESULTS

Compared with normal and elevated groups, patients with extremely elevated CEA had more advanced T,N,M stages (P<0.01), more palliative surgery (P<0.01) and more lymphovascular invasion(P<0.01). During the follow-up, patients with extremely elevated CEA demonstrated significantly higher ratio of distant metastases and liver metastases (both P=0.001). After radical surgery, 5-year overall survival rate of patients with normal, elevated and extremely elevated CEA levels was 70.1%, 54.4% and 42%, respectively, with statistically significant difference among three groups (P<0.001). Multivariate analysis showed that tumor differentiation, TNM staging, preoperative CEA levels, lymphovascular invasion and adjuvant chemotherapy were independent prognostic factors for colon cancer (all P<0.01).

CONCLUSIONS

Colon cancer patients with extremely elevated preoperative CEA levels are associated with more unfavorable pathological factors, advanced TNM stage and more distant metastases (especially the liver metastases) during the follow-up. The elevated degree of preoperative CEA level is an independent poor prognostic factor of patients with colon cancer.

摘要

目的

探讨术前血清癌胚抗原（CEA）水平极度升高（>50μg/L）的结肠癌患者的临床病理特征及预后。

方法

回顾性分析2001年1月至2011年12月期间1250例行原发性肿瘤切除的结肠腺癌患者的临床病理及随访资料。所有患者根据术前血清CEA水平分为三组，即正常组（0 - 5μg/L，721例）、升高组（5 - 50μg/L，408例）和极度升高组（>50μg/L，121例）。采用Kaplan-Meier法分析总生存和无病生存情况。采用Log-rank检验比较组间生存情况。采用Cox回归筛选结肠癌的独立预后因素。

结果

与正常组和升高组相比，CEA极度升高的患者T、N、M分期更晚（P<0.01），姑息性手术更多（P<0.01），且淋巴管侵犯更多（P<0.01）。随访期间，CEA极度升高的患者远处转移和肝转移比例显著更高（均P = 0.001）。根治性手术后，CEA水平正常、升高和极度升高的患者5年总生存率分别为70.1%、54.4%和42%，三组间差异有统计学意义（P<0.001）。多因素分析显示，肿瘤分化、TNM分期、术前CEA水平、淋巴管侵犯和辅助化疗是结肠癌的独立预后因素（均P<0.01）。