血清肿瘤生物标志物评分系统对新辅助放化疗的临床II/III期直肠癌的预测价值
Predictive value of a serum tumor biomarkers scoring system for clinical stage II/III rectal cancer with neoadjuvant chemoradiotherapy.
作者信息
Zhao Jie-Yi, Tang Qing-Qing, Luo Yu-Ting, Wang Shu-Min, Zhu Xiao-Rui, Wang Xiao-Yu
机构信息
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
出版信息
World J Gastrointest Oncol. 2022 Oct 15;14(10):2014-2024. doi: 10.4251/wjgo.v14.i10.2014.
BACKGROUND
Multiple classes of molecular biomarkers have been studied as potential predictors for rectal cancer (RC) response. Carcinoembryonic antigen (CEA) is the most widely used blood-based marker of RC and has proven to be an effective predictive marker. Cancer antigen 19-9 (CA19-9) is another tumor biomarker used for RC diagnosis and postoperative monitoring, as well as monitoring of the therapeutic effect. Using a panel of tumor markers for RC outcome prediction is a practical approach.
AIM
To assess the predictive effect of pre-neoadjuvant chemoradiotherapy (NCRT) CEA and CA19-9 levels on the prognosis of stage II/III RC patients.
METHODS
CEA and CA19-9 levels were evaluated 1 wk before NCRT. According to the receiver operating characteristic curve analysis, the optimal cut-off point of CEA and CA19-9 levels for the prognosis were 3.55 and 19.01, respectively. The novel serum tumor biomarker (NSTB) scores were as follows: score 0: Pre-NCRT CEA < 3.55 and CA19-9 < 19.01; score 2: Pre-NCRT CEA > 3.55 and CA19-9 > 19.01; score 1: Other situations. Pathological information was recorded according to histopathological reports after the operation.
RESULTS
In the univariate analysis, pre-NCRT CEA < 3.55 [ = 0.025 for overall survival (OS), = 0.019 for disease-free survival (DFS)], pre-NCRT CA19-9 < 19.01 ( = 0.014 for OS, = 0.009 for DFS), a lower NSTB score (0-1 2, = 0.009 for OS, = 0.005 for DFS) could predict a better prognosis. However, in the multivariate analysis, only a lower NSTB score (0-1 2; for OS, HR = 0.485, 95%CI: 0.251-0.940, = 0.032; for DFS, HR = 0.453, 95%CI: 0.234-0.877, = 0.019) and higher pathological grade, node and metastasis stage (0-I II-III; for OS, HR = 0.363, 95%CI: 0.158-0.837, = 0.017; for DFS, HR = 0.342, 95%CI: 0.149-0.786, = 0.012) were independent predictive factors.
CONCLUSION
The combination of post-NCRT CEA and CA19-9 was a predictive factor for clinical stage II/III RC patients receiving NCRT, and the combined index had a stronger predictive effect.
背景
多类分子生物标志物已被作为直肠癌（RC）反应的潜在预测指标进行研究。癌胚抗原（CEA）是RC最广泛使用的血液标志物，已被证明是一种有效的预测标志物。癌抗原19-9（CA19-9）是另一种用于RC诊断、术后监测以及治疗效果监测的肿瘤生物标志物。使用一组肿瘤标志物来预测RC的预后是一种实用的方法。
目的
评估新辅助放化疗（NCRT）前CEA和CA19-9水平对II/III期RC患者预后的预测作用。
方法
在NCRT前1周评估CEA和CA19-9水平。根据受试者工作特征曲线分析，CEA和CA19-9水平用于预后的最佳截断点分别为3.55和19.01。新型血清肿瘤生物标志物（NSTB）评分如下：0分：NCRT前CEA<3.55且CA19-9<19.01；2分：NCRT前CEA>3.55且CA19-9>19.01；1分：其他情况。术后根据组织病理学报告记录病理信息。
结果
单因素分析中，NCRT前CEA<3.55（总生存期（OS），P = 0.025；无病生存期（DFS），P = 0.019），NCRT前CA19-9<19.01（OS，P = 0.014；DFS，P = 0.009），较低的NSTB评分（0-1 vs 2，OS，P = 0.009；DFS，P = 0.005）可预测较好的预后。然而，多因素分析中，只有较低的NSTB评分（0-1 vs 2；对于OS，HR = 0.485，95%CI：0.251-0.940，P = 0.032；对于DFS，HR = 0.453，95%CI：0.234-0.877，P = 0.019）以及更高的病理分级、淋巴结和转移分期（0-I vs II-III；对于OS，HR = 0.363，95%CI：0.158-0.837，P = 0.017；对于DFS，HR = 0.342，95%CI：0.149-0.786，P = 0.012）是独立的预测因素。
结论
NCRT后CEA和CA19-9的联合是接受NCRT的临床II/III期RC患者的一个预测因素，且联合指标具有更强的预测作用。
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