围手术期CEA、CA199及其比值对结直肠癌术后预后的价值

发布时间：2018-02-28 08:43

本文关键词： CEA CA199 结直肠癌预后复发　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨围手术期CEA、CA199及其比值对结直肠癌术后预后的价值。方法回顾分析于2012年9月至2014年9月在广西医科大学第一附属医院病理确诊为结直肠癌并接受手术治疗及符合纳入标准的231例结直肠癌患者。分别于术前、术后1-2周利用化学发光法检测术前血清CEA、CA199水平和术后血清CEA、CA199水平,及计算出CEA ratio、CA199ratio。c2检验分别分析上述六个观察指标与结直肠癌患者临床病理参数的关系,Kaplan-Meier生存曲线分别分析上述六个观察指标与结直肠癌生存预后的关系,COX回归模型多因素分析影响结直肠癌术后预后的因素。结果(1)c2检验显示术前血清CEA阳性在肿瘤远处转移(P=0.029)、TNM分期(P=0.031)中的差异具有统计学意义。术前血清CA199阳性在肿瘤浸润深度(P=0.023)、淋巴结转移(P=0.003)、TNM分期(P=0.000)、组织分化程度(P=0.035)中的差异具有统计学意义。术后血清CEA阳性在肿瘤远处转移(P=0.003)、TNM分期(P=0.016)中的差异具有统计学意义。术后血清CA199阳性在肿瘤远处转移(P=0.027)、淋巴结转移(P=0.004)、TNM分期(P=0.000)中的差异具有统计学意义。CEAratio、CA199ratio与所统计的临床病理参数间差异均无统计学意义(P0.05)。(2)Kaplan-Meier生存曲线分析表明,相比术前CEA阴性的患者,术前CEA阳性与结直肠癌术后总生存期无显著相关性(P=0.122);与术后CEA阴性、术前/术后CA199阴性、CEA ratio1、CA199 ratio1的患者相比,术后CEA阳性、术前/术后CA199阳性、CEA ratio1、CA199ratio1的患者的3年总生存期均明显缩短(P0.05)。(3)COX回归模型多因素分析显示术前血清CA199阳性、CEA ratio1、CA199ratio1、淋巴结转移、肿瘤远处转移为结直肠癌术后预后的独立危险因素。结论1、术前血清CA199阳性是结直肠癌术后预后的独立危险因素,术前或术后血清CEA水平与淋巴结转移、TNM分期等病理因素有关,但不是结直肠癌术后预后的独立危险因素。2、CEA ratio1、CA199 ratio1可能是结直肠癌术后预后不良的独立危险因素之一,但需要加大样本量来进一步研究证实。
[Abstract]:Objective to investigate the value of CEACA199 and its ratio in postoperative prognosis of colorectal cancer during perioperative period. Methods from September 2012 to September 2014, we retrospectively analyzed the pathologically diagnosed colorectal cancer and received surgical treatment in the first affiliated Hospital of Guangxi Medical University. All 231 patients with colorectal cancer who met the inclusion criteria were treated preoperatively. At 1-2 weeks after operation, chemiluminescence assay was used to detect the serum levels of CEACA199 before and after operation. The relationship between the above six observation indexes and the clinicopathological parameters of colorectal cancer patients was calculated by CEA ratio.c2 test. Kaplan-Meier survival curve was used to analyze the relationship between the above six observation indexes and the survival prognosis of colorectal cancer respectively and Cox regression model was used to analyze the relationship between the above six indexes and the prognosis of colorectal cancer. Multivariate analysis of the prognostic factors of postoperative colorectal cancer. Results the preoperative serum CEA positive was significantly different in the distant metastasis of tumor P0. 029. The preoperative serum CA199 was positive in the depth of tumor invasion. There were significant differences in the levels of CEA in the patients with lymph node metastasis (P 0.003) and in the stage of TNM (P 0. 000, P 0. 035). There was a significant difference in the expression of serum CEA in the patients with distant metastasis (P 0. 003) and the positive rate of serum CA199 in the patients with distant tumor metastasis (P 0. 016) after operation, there was a significant difference in the level of serum CA199 in the patients with distant metastasis of the tumor (P < 0. 003 or P 0. 016). There was no significant difference between P0. 027, P0. 004, TNM staging and P0. 000). There was no significant difference between the CA ratio of CEAratiografts and the clinicopathologic parameters. The analysis of survival curve of P0. 05 and Kaplan-Meier showed that there was no significant difference between P0. 05 and P0. 004. There was no significant correlation between preoperative CEA positive and total postoperative survival time of colorectal cancer compared with preoperative CEA negative patients, but no significant correlation between preoperative CEA positive and postoperative CEA negative CA199 negative CEA ratio1 CA199 ratio1. The 3-year total survival time of the patients with CA199 positive CA199 / CA199ratio1 was significantly shortened by multivariate analysis of multivariate regression model (P0.05). The results of multivariate analysis showed that the preoperative serum CA199 positive patients with CEA ratio1 / CA199ratio1 had lymph node metastasis. Conclusion 1. Preoperative serum CA199 positive is an independent risk factor for postoperative prognosis of colorectal cancer. Preoperative or postoperative serum CEA levels are associated with pathological factors such as lymph node metastasis and TNM staging. But it is not an independent risk factor for postoperative prognosis of colorectal cancer. 2CEA ratio1 CA199 ratio1 may be one of the independent risk factors for poor prognosis of colorectal cancer.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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