Hung Hsin-Yuan, Chen Jinn-Shiun, Tang Reiping, Hsieh Pao-Shiu, You Yau-Tong, You Jeng-Fu, Chiang Jy-Ming
Department of Colorectal Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Linko, Taiwan, 5, Fu-Hsing St., Kuei-Shan, Tao-Yuan, Taiwan.
Int J Colorectal Dis. 2017 Dec;32(12):1775-1778. doi: 10.1007/s00384-017-2907-4. Epub 2017 Oct 13.
Purpose To assess preoperative serum alkaline phosphatase (ALP) levels in colon adenocarcinomapatients with various clinical features and determine its prognostic value.
Between 2000 and 2013, 10,800 stage I-IV colon cancer patients who underwent surgery wereretrospectively enrolled. The relationship between ALP level and variables, including age, gender,carcinoembryonic Antigen (CEA) levels, aspartate aminotransferase (AST) level, bilirubin level, tumor size,liver cirrhosis, hepatitis, albumin level, histological type, and TNM-stage, were evaluated. The impact of ALP level elevation on survival was evaluated.
Significant elevations in ALP level were found in patients with CEA ≥5 ng/ml (p<0.001); AST |≥43 U/L (p<0.001); total bilirubin ≥1.5 U/L (p<0.001); liver cirrhosis (p<0.001); albumin; <3.5g/dL (p <0.001); and stage IV disease (p=0.03).Patients with elevated ALP levels had significantly worse 5-year overall survival (OS) for colon (5-year OSrate: 71.5% vs. 78.3%, p<0.001; Fig. 1a) and rectal (5-year OS rate: 64.5% vs. 72.3%, p<0.001; Fig. 1b)cancer than patients with normal ALP levels.
Elevated preoperative ALP levels was not only associated with liver disease, but it was alsorelated with advanced tumor status, and indicated a poor survival in colon and rectal cancer patients.
评估具有不同临床特征的结肠腺癌患者术前血清碱性磷酸酶（ALP）水平，并确定其预后价值。
回顾性纳入2000年至2013年间接受手术的10800例I-IV期结肠癌患者。评估ALP水平与年龄、性别、癌胚抗原（CEA）水平、天冬氨酸转氨酶（AST）水平、胆红素水平、肿瘤大小、肝硬化、肝炎、白蛋白水平、组织学类型和TNM分期等变量之间的关系。评估ALP水平升高对生存的影响。
CEA≥5 ng/ml（p<0.001）、AST≥43 U/L（p<0.001）、总胆红素≥1.5 U/L（p<0.001）、肝硬化（p<0.001）、白蛋白<3.5 g/dL（p<0.001）和IV期疾病（p=0.03）患者的ALP水平显著升高。ALP水平升高的患者，结肠癌（5年总生存率：71.5%对78.3%，p<0.001；图1a）和直肠癌（5年总生存率：64.5%对72.3%，p<0.001；图1b）的5年总生存率明显低于ALP水平正常的患者。
术前ALP水平升高不仅与肝脏疾病有关，还与肿瘤进展状态相关，提示结肠癌和直肠癌患者生存率较低。
