TNMⅠ~Ⅲ期结直肠癌病人治疗前血清癌胚抗原水平与预后的关系

目的评价治疗前癌胚抗原水平与Ⅰ~Ⅲ期结直肠癌病人预后的关系。方法回顾性分析广州市第一人民医院2003年1月 ~2013 年12 月收治的393 例结直肠癌病人的临床病例资料，以5 ng/mL 为标准分为未升高组（CEA<5 ng/mL）257 例，升高组 （CEA≥5 ng /mL）136例，比较两组病人临床、病理数据及预后。结果两组病人的肿瘤大小、分化程度、淋巴结转移的差异有统 计学意义（P<0.05）。Cox比例风险模型提示，术前高CEA水平是影响病人术后生存及复发的危险因素，升高组病人死亡及复发 风险分别提高1.59及1.89倍。在随访期内，升高组的死亡率为28.7%、复发率为32.4%，均高于未升高组的19.8%和19.1%，差异 有统计学意义（P<0.05），升高组病人的累积总生存率及累积无瘤生存率明显低于未升高组病人，差异有统计学意义（P<0.05）， 在TNM Ⅲ期病人中，升高组病人的累积总生存率及累积无瘤生存率明显低于未升高组病人，差异有统计学意义（P<0.05）。结 论在TNM分期系统中加入治疗前癌胚抗原水平后可产生新的生存及复发数据，指导临床医生更准确的判断病人的预后。

Prognostic value of preoperative carcinoembryonic antigen level in patients with stage I-III colorectal cancer

Objective To evaluate the prognostic value of preoperative serum carcinoembryonic antigen (CEA) level in patients with stage I-III colorectal cancer. Methods The clinicopathological data and prognosis were retrospectively analyzed for 393 patients with colorectal cancer treated in our hospital from January, 2003 to December, 2013. Of these patients, 136 had elevated serum CEA level (≥5 ng/mL) and 257 did not show serum CEA elevation (<5 ng/mL). Results The two groups of patients showed significant differences in the tumor size, degree of tumor differentiation and lymph node metastasis (P<0.05). Cox proportional hazards model suggested that an elevated preoperative CEA level was a risk factor for survival and tumor recurrence, and increased the risks of death and tumor recurrence by 1.59 and 1.89 folds, respectively. Compared with the patients without CEA elevation, those with elevated CEA level had a significantly higher mortality rate (28.7% vs 19.8%, P<0.05) and tumor recurrence rate (32.4% vs 19.1%, P<0.05) with a significantly lower cumulative total survival rate and cumulative disease-free survival rate (P<0.05);the same results were also found in stage-Ⅲpatients (P<0.05). Conclusions New survival and recurrence data can be generated by incorporating serum CEA level in TNM staging system for more accurate prognostic assessment of the patients.