术前血清CA125预测胃癌腹膜转移的单中心大样本临床研究

目的:探讨术前血清CA125等肿瘤标志物对胃癌腹膜转移的预测价值。方法:术前检测1 348例胃癌病人的血清CA125、CA19-9、CA72-4和CEA水平,其检测值与临床病理参数作分析。结果:受试者工作特征(ROC)分析显示,血清CA125对胃癌腹膜转移术前判断的准确率最高,CA125、CA19-9、CA72-4和CEA的ROC曲线下面积分别为0.85、0.61、0.71和0.43。ROC分析进一步显示,血清CA125预测腹水的诊断价值较高(ROC曲线下面积为0.97),并且血清CA125水平与腹水量密切相关(r=0.686,P0.001)。以35 u/mL作为血清CA125的临界值,血清CA125预测胃癌腹膜转移的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为43.6%(41/94)、96.5%(1210/1254)、48.2%(41/85)、95.8%(1 210/1 263)和92.8%(1 251/1 348)。此外,血清CA125对伴有腹水胃癌腹膜转移的灵敏度较无腹水的胃癌腹膜转移显著增高(79.4%比23.3%,P0.001)。结论:术前血清CA125对胃癌腹膜转移的预测价值较高,且血清CA125水平与腹水量密切相关。

Value of pre-operative serum CA125 level in predicting the peritoneal metastasis of gastric cancer： a single-centerand large-scale study

Objective To investigate the value of serum tumor markers including CA125 and others in predicting peritoneal metastasis of gastric cancer. Methods The pre-operative serum tumor marker levels of CA125, CA19-9, CA72- 4, and CEA were measured in 1 348 gastric cancer patients. The levels of tumor markers were analyzed with clinical and pathological parameters. Results Receiver operating characteristic （ROC） analysis showed that the accuracy of the serum CA125 level for evaluation of peritoneal metastasis of gastric cancer was the highest （area under ROC curve of CA125, CA19-9, CA72-4, and CEA was 0.85, 0.61, 0.71, and 0.43, respectively）. ROC analysis further showed that the diagnostic value of serum CA125 level for predicting ascites was very high （area under ROC curve was 0.97）. Correlation was present between the volume of ascites fluid and serum CA125 level （r=0.686, P〈0.001）. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of serum CA125 in predicting peritoneal metastasis of gastric cancer were 43.6% （41/94）, 96.5% （1 210/1 254）, 48.2% （41/85）, 95.8% （1 210/1 263） and 92.8% （1 251/1 348）, respectively, when the positive prediction was based on CA125 level over cut-off value （35 u/mL）. The sensitivity of serum CA125 in predicting peritoneal metastasis for gastric cancer with ascites was higher than that without ascites （79.4% vs 23.3%, P〈0.001）. Conclusions The value of pre-operative serum CA125 level in predicting peritoneal metastasis of gastric cancer is higher. The serum CA125 level is correlated with the volume of ascites fluid.