Patel D D, Bhatavdekar J M, Ghosh N, Vora H H, Karelia N H, Shah N G, Suthar T P, Balar D B, Trivedi C R
Division of Research, Gujarat Cancer Society, Asarwa, Ahmedabad, India.
Cancer. 1994 Feb 1;73(3):570-4. doi: 10.1002/1097-0142(19940201)73:3<570::aid-cncr2820730312>3.0.co;2-i.
Preoperative plasma prolactin and carcinoembryonic antigen (CEA) levels were assessed to monitor disease recurrence and to identify low-risk and high-risk patients with Dukes B or C colorectal cancer.
Prolactin and CEA were estimated by radioimmunoassay method. Blood samples were collected preoperatively and sequentially thereafter from patients with colorectal cancer (N = 114); the samples were compared with samples from age-matched healthy control subjects (smokers and nonsmokers, N = 45). For rest of the analysis, patients with Dukes A disease (N = 7) were not included because of the small number. In monitoring recurrences, the criteria for positive test for the two markers was a continual increase in the marker level after an initial decrease or persistent high level of the marker. These were the indicators of relapse or no response to treatment. To determine the efficacy of the preoperative markers, the patients were grouped according to disease status at the end of 3 years, i.e., patients who had response to the treatment modalities (N = 52) and patients who later had progressive disease (N = 55). To determine the prognostic significance of preoperative marker levels, the patients were divided according to the cutoff levels (upper normal limits); for prolactin the cutoff level was 20.0 ng/ml plasma, and for CEA it was 5.0 ng/ml plasma.
Both of the markers were significantly high in patients with colorectal cancer compared with the markers of their respective control subjects (P < 0.0001). In monitoring disease course, the predictive power of prolactin was 100%, whereas that of CEA was 66%. Prolactin showed a lead time of 2-3 months. Preoperative prolactin levels were significantly higher in patients who later had progressive disease (P < 0.001) than in patients who had response to the treatments. However, such an intergroup variation was not observed for CEA. Patients with preoperative levels of prolactin greater than 20.0 ng/ml had shorter overall survival times than did those with prolactin levels less than 20.0 ng/ml plasma; such a trend was not observed for patients with CEA levels less than 5.0 ng/ml and those with CEA levels greater than 5.0 ng/ml plasma.
Prolactin is a better overall marker than is CEA in patients with Dukes B or C colorectal cancer. The authors recommend the use of plasma prolactin levels to help identify low-risk and high-risk patient subgroups so that high-risk patients may be followed up more intensely and treated accordingly. Hyperprolactinemic patients with Dukes B or C disease have shortened survival time.
评估术前血浆催乳素和癌胚抗原（CEA）水平，以监测疾病复发，并识别Dukes B或C期结直肠癌的低风险和高风险患者。
采用放射免疫分析法测定催乳素和CEA。术前及随后依次采集结直肠癌患者（N = 114）的血样；将这些样本与年龄匹配的健康对照受试者（吸烟者和非吸烟者，N = 45）的样本进行比较。在其余分析中，由于数量较少，未纳入Dukes A期疾病患者（N = 7）。在监测复发时，两种标志物检测呈阳性的标准为标志物水平在最初下降后持续升高或持续处于高水平。这些是复发或对治疗无反应的指标。为了确定术前标志物的有效性，根据3年末的疾病状态对患者进行分组，即对治疗方式有反应的患者（N = 52）和后来病情进展的患者（N = 55）。为了确定术前标志物水平的预后意义，根据临界值（正常上限）对患者进行划分；催乳素的临界值为血浆20.0 ng/ml，CEA的临界值为血浆5.0 ng/ml。
与各自对照受试者的标志物相比，结直肠癌患者的这两种标志物均显著升高（P < 0.0001）。在监测病程时，催乳素的预测能力为100%，而CEA为66%。催乳素显示出2 - 3个月的提前期。后来病情进展的患者术前催乳素水平显著高于对治疗有反应的患者（P < 0.001）。然而，CEA未观察到这种组间差异。术前催乳素水平大于20.0 ng/ml的患者总生存时间短于催乳素水平小于20.0 ng/ml血浆的患者；血浆CEA水平小于5.0 ng/ml和大于5.0 ng/ml的患者未观察到这种趋势。
在Dukes B或C期结直肠癌患者中，催乳素是比CEA更好的总体标志物。作者建议使用血浆催乳素水平来帮助识别低风险和高风险患者亚组，以便对高风险患者进行更密切的随访并相应治疗。Dukes B或C期疾病的高催乳素血症患者生存时间缩短。
