Kouri M, Nordling S, Kuusela P, Pyrhönen S
Department of Radiotherapy and Oncology, Helsinki University Central Hospital, Finland.
Eur J Cancer. 1993;29A(12):1691-6. doi: 10.1016/0959-8049(93)90106-p.
DNA ploidy, S-phase fraction (SPF) for the tumours, serum tumour markers such as carcinoembryonic antigen (CEA) and serum CA 19-9 and major clinical parameters were analysed as prognostic factors in 105 patients with advanced colorectal carcinoma. All 105 were treated with a three-drug schedule including low dose epirubicin and sequential methotrexate, 5-fluorouracil, followed by leucovorin rescue. In univariate analysis, gender, Karnofsky index, extent of metastases, presence of abdominal metastases, CEA and CA 19-9 correlated with survival. Age, presence of liver or of lung metastases, DNA ploidy or SPF were not significantly associated with survival. In stepwise multivariate analysis an elevated serum CA 19-9 level, a poor Karnofsky index and multiple sites of metastases were independent adverse prognostic factors. Based on the multivariate analysis, patients were grouped in three categories. Group 1 consisted of 32 patients with Karnofsky > or = 80, with a normal serum CA 19-9 level and a single site of metastases. Group 2 consisted of 48 patients with Karnofsky > or = 80 and with an elevated serum CA 19-9 level or multiple sites of metastases. Group 3 consisted of 14 patients with Karnofsky < or = 70. This classification gave a highly significant correlation with survival (chi 2 = 45.52, P < 0.001, log rank test). The median survival in group 1, group 2 and group 3 was 30.1 months, 13.5 months and 3.9 months, respectively. Based on these results we suggest that trials involving advanced colorectal cancer should include the measurement of serum CA 19-9 levels as one of the most important prognostic factors, but also include documentation of other independent prognostic factors.
对105例晚期结直肠癌患者的DNA倍体、肿瘤的S期分数（SPF）、血清肿瘤标志物如癌胚抗原（CEA）和血清CA 19-9以及主要临床参数进行了分析，作为预后因素。所有105例患者均接受了包括低剂量表柔比星以及序贯甲氨蝶呤、5-氟尿嘧啶，随后进行亚叶酸解救的三药方案治疗。单因素分析中，性别、卡诺夫斯基指数、转移范围、腹部转移的存在、CEA和CA 19-9与生存相关。年龄、肝或肺转移的存在、DNA倍体或SPF与生存无显著关联。逐步多因素分析中，血清CA 19-9水平升高、卡诺夫斯基指数差和多个转移部位是独立的不良预后因素。基于多因素分析，患者被分为三类。第1组由32例卡诺夫斯基指数≥80、血清CA 19-9水平正常且单一转移部位的患者组成。第2组由48例卡诺夫斯基指数≥80且血清CA 19-9水平升高或多个转移部位的患者组成。第3组由14例卡诺夫斯基指数≤70的患者组成。这种分类与生存具有高度显著的相关性（χ2 = 45.52，P < 0.001，对数秩检验）。第1组、第2组和第3组的中位生存期分别为30.1个月、13.5个月和3.9个月。基于这些结果，我们建议涉及晚期结直肠癌的试验应将血清CA 19-9水平的测定作为最重要的预后因素之一，但也应包括其他独立预后因素的记录。
