Schellerer Vera S, Langheinrich Melanie C, Zver Veronika, Grützmann Robert, Stürzl Michael, Gefeller Olaf, Naschberger Elisabeth, Merkel Susanne
Department of Surgery, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Germany.
Division of Molecular and Experimental Surgery, Department of Surgery, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Int J Colorectal Dis. 2019 Feb;34(2):309-317. doi: 10.1007/s00384-018-3198-0. Epub 2018 Nov 23.
Serological tumor markers are routinely used to monitor tumor onset and progression. In colorectal carcinoma (CRC), the carcinoembryonic antigen (CEA) is roughly elevated in 50% of patients at initial diagnosis. Soluble ICAM-1 (sICAM-1) is elevated in different cancers. The aim of this study was to evaluate the prognostic relevance of sICAM-1 combined with CEA in patients with CRC.
In blood samples of 297 CRC patients, sICAM-1 was determined by ELISA and CEA by microparticle enzyme immunoassay the day before oncologic resection. Separation in patients with sICAM-1 and sICAM-1 was performed by minimum p value approach; separation in CEA normal and elevated was performed according to the established diagnostic cutoff. Clinical data were obtained from the prospective collected data from the Erlangen Registry for Colorectal Carcinomas.
Cancer-related 5-year survival rate of patients with sICAM-1 (< 290 ng/ml, n = 208) was significantly increased (83.4%) as compared to that of patients with sICAM-1 (≥ 290 ng/ml, n = 89) (66.2%; p < 0.001). Patients with normal CEA concentrations (n = 199; 90.8%) showed a significantly (p < 0.001) improved cancer-related 5-year survival rate compared to patients with elevated CEA concentrations (n = 98; 52.1%). Moreover, high sICAM-1 was an independent risk factor (hazard ratio 1.6) in multivariate analysis. Of note, increased sICAM-1 levels, either within normal or within elevated CEA, allowed to identify high-risk subgroups, both for overall (p < 0.001) and cancer-related survival (p < 0.001).
Application of a novel risk score combining CEA/sICAM-1 serum concentrations allows the identification of high-risk groups for poor survival in CRC patients.
血清肿瘤标志物常用于监测肿瘤的发生和进展。在结直肠癌（CRC）中，约50%的患者在初诊时癌胚抗原（CEA）会大致升高。可溶性细胞间黏附分子-1（sICAM-1）在不同癌症中均有升高。本研究旨在评估sICAM-1联合CEA对CRC患者的预后相关性。
在297例CRC患者的血液样本中，于肿瘤切除术前一天通过酶联免疫吸附测定（ELISA）法测定sICAM-1，通过微粒酶免疫测定法测定CEA。采用最小p值法对sICAM-1水平高低的患者进行分组；根据既定的诊断临界值对CEA正常和升高的患者进行分组。临床数据来自埃尔朗根结直肠癌登记处前瞻性收集的数据。
sICAM-1水平<290 ng/ml的患者（n = 208）的癌症相关5年生存率（83.4%）显著高于sICAM-1水平≥290 ng/ml的患者（n = 89）（66.2%；p < 0.001）。CEA浓度正常的患者（n = 199；90.8%）的癌症相关5年生存率相比CEA浓度升高的患者（n = 98；52.1%）显著提高（p < 0.001）。此外，在多变量分析中，高sICAM-1是一个独立的危险因素（风险比1.6）。值得注意的是，无论是在CEA正常还是升高的情况下，sICAM-1水平升高均能识别出总体生存（p < 0.001）和癌症相关生存（p < 0.001）的高危亚组。
应用结合CEA/sICAM-1血清浓度的新型风险评分可识别CRC患者中生存不良的高危组。
