CA19-9、CA125和CP2在卵巢黏液性肿瘤诊断和监测中的价值

目的探讨血清肿瘤标志物CA19-9、CA125及CP2在卵巢黏液性肿瘤诊断和监测中的价值。方法对北京大学人民医院1999年1月至2007年6月间收治的273例卵巢肿瘤患者的临床资料进行回顾性分析,探讨血清肿瘤标志物CA19-9、CA125及CP2在50例卵巢黏液性肿瘤诊断和监测中的价值,并与223例卵巢非黏液性肿瘤进行比较。结果（1）卵巢黏液性肿瘤中,CA19-9的曲线下面积最大（为0．95）,其次是CA125（为0．90）;而卵巢非黏液肿瘤中,CA125和CP2的曲线下面积最大（均为0．90）。（2）卵巢黏液性肿瘤患者联合检测CA19-9和CA125时,其敏感度（93．8％）较单项检测（CA19-9和CA125分别为75．0％和66．7％）明显提高（P〈0．05）,而特异度（分别为86．1％、86．6％和90．2％）无明显变化（P〉0．05）。卵巢非黏液性肿瘤患者联合检测CA125和CP2时的敏感度（85．0％）,较CP2（70．6％）单项检测明显提高,差异有统计学意义（P〈0．05）;较CA125（80．7％）单项检测虽有提高,但差异无统计学意义（P〉0．05）;3者的特异度（分别为90．2％、88．5％和93．9％）比较,差异无统计学意义（P〉0．05）。（3）82例卵巢恶性肿瘤术前血清肿瘤标志物阳性患者中。可行满意的肿瘤细胞减灭术患者[70％（57／82）]的血清肿瘤标志物于术后2个月内降为正常的百分率高于未能行满意肿瘤细胞减灭术者（分别为75％和28％）,差异有统计学意义（P〈0．05）;且其术后血清肿瘤标志物再次上升的平均时间延长（分别为18．2和16．4个月）,但差异无统计学意义（P〉0．05）;复发率（分别为35％和56％）及死亡率（分别为14％和32％）降低,差异有统计学意义（P〈0．05）。20例术前血清肿瘤标志物阴性患者均可行满意的肿瘤细胞减灭术,其中复发患者仅2例（10％）。（4）卵巢黏液性肿瘤患者术后复发时多为血清CA19-9水平上升,而卵巢非黏液性肿瘤术后复发时主要为血清CA125水平上升,部分患者血清CP2水平也上升。（5）术前血清肿瘤标志物阳性患者较阴性患者生存率明显下降,其中CA125（＋）与CA125（-）、CP2（＋）与CP2（-）患者间生存率比较,差异有统计学意义（P〈0．05）;而CA19-9（＋）与CA19-9（-）患者间生存率比较,差异则无统计学意义（P〉0．05）。结论CA19-9是诊断卵巢黏液性肿瘤的敏感指标,与CA125联合检测可提高对卵巢黏液性肿瘤诊断的敏感度,并对术后监测有重要临床意义。CA125和CP2联合检测则对诊断卵巢非黏液肿瘤更敏感。

Clinical value of serum CA19-9, CA125 and CP2 in mucinous ovarian tumor: a retrospective study of 273 patients

OBJECTIVE: To evaluate the diagnostic and prognostic value of serum CA19-9, CA125 and CP2 in mucinous ovarian tumors. METHODS: In this retrospective study, the serum CA19-9, CA125 and CP2 levels of 273 hospitalized patients with ovarian tumors of either mucinous or non-mucinous type were analyzed. RESULTS: (1) CA19-9 had the biggest area under curve (AUC) in mucinous tumors followed with CA125 while CA125 and CP2 had bigger AUC in non-mucinous tumor. (2) For the diagnosis of mucinous tumors, CA19-9 and CA125 combination showed a greatly increased sensitivity compared with CA19-9 or CA125 alone (93.8% versus 75.0% and 66.7%, P<0.05) with no significant improvement of the specificity (P>0.05). For the diagnosis of non-mucinous tumors, CA125 and CP2 combination showed an increased sensitivity compared with CA125 or CP2 alone (85.0% versus 80.7%, P>0.05, 85.0% versus 70.6%, P<0.05) with no significant improvement of the specificity (P>0.05). (3) Seventy percent of tumor marker-positive patients could undergo cytoreductive surgery. Compared with those who could not undergo cytoreductive surgery, they were more likely to have normal tumor marker two months after surgery (P<0.05) and longer interval to re-elevation of tumor markers (P>0.05), with lower recurrence and death rate (P<0.05). All of the 20 tumor marker-negative patients could have cytoreductive surgery with only 10% recurrence. (4) CA19-9 increased mainly in recurrent mucinous tumor, while CA125 increased dominantly in recurrent non-mucinous tumor. (5) The survival rate of CA125 and CP2 positive patients was much lower than CA125 and CP2 negative patients (P<0.05), while the survival rate was similar between CA19-9 positive and CA19-9 negative patients. CONCLUSIONS: CA19-9 is a sensitive index for diagnosis of mucinous ovarian tumors. Combination of CA19-9 with CA125 can improve the sensitivity of diagnosis and postoperative monitoring of mucinous ovarian tumors. Combination of CA125 with CP2 is more valuable in the diagnosis of non-mucinous ovarian tumors.