血清VEGF、CA19-9以及OPN水平检测在大肠癌的临床诊断和手术疗效分析中的应用

目的:探讨大肠癌患者手术前后血清VEGF、CA19-9和OPN的含量变化及其临床意义。方法:对50例大肠癌患者VEGF、CA19-9、OPN以及CEA 联合检测判断大肠癌阳性检出率,并测定术前、术后5天和术后10天血清血管内皮生长因子（VEGF）、糖蛋白抗原CA19-9以及骨桥素（OPN）的含量。结果:VEGF、CA19-9和OPN三者联合检测时大肠癌检出率高于单独检测CEA。手术后5天以及手术后10天患者血清中VEGF、CA19-9以及OPN水平与术前相比有明显降低（P＜0.05）。大肠癌TNM I和II期患者血清中三种肿瘤标志物含量明显低于III和IV期患者(P＜0.05);中-低分化（包括未分化）患者血清中VEGF、CA19-9以及OPN水平高于高分化患者,两组比较具有统计学意义（P＜0.05）。结论:血清VEGF、CA19-9和OPN水平可作为大肠癌临床分期、判断预后和恶性程度的依据,可作为大肠癌诊断、分期、预后判断的重要指标,值得临床推广应用。     

外周血内CA19-9、CA242及CEA对胰腺癌诊断及病理分期评估的价值

目的：分析糖类抗原19-9（carbohydrate antigen 19-9,CA19-9）、CA242、癌胚抗原（carcino-embryonic anti-gen,CEA）联合检测诊断胰腺癌的临床价值及其对临床分期判断的指导作用。方法选取95例胰腺癌患者为患者组,及同期60例健康体检者为对照组,比较两组受试者血清CA19-9、CA242和CEA的表达水平,计算血清CA19-9、CA242、CEA单独检测及联合检测诊断胰腺癌的敏感度、特异度和准确性,并比较不同临床分期胰腺癌患者血清CA19-9、CA242、CEA的差异,评价上述指标对胰腺癌临床分期判断的指导作用。结果患者组血清 CA19-9、CA242、CEA水平均高于对照组,差异均具有统计学意义（均P＜0．05）。联合检测诊断胰腺癌的敏感度、特异度和准确性分别为96．8％、66．7％、85．2％,其敏感度、准确性均优于单项检测。随着患者病理分期的增加,其血清CA19-9、CA242、CEA水平均升高,差异均具有统计学意义（均P＜0．05）。患者组治疗后6个月血清CA19-9、CA242、CEA水平均较术前降低,差异均具有统计学意义（均P＜0．05）。肿瘤直径≥5 cm者、肿瘤位于胰腺体／尾部者,其血清CA19-9、CA242、CEA水平均高于肿瘤直径＜5 cm 者及肿瘤位于胰腺头部或全胰腺者,差异均具有统计学意义（均 P＜0.05）。结论联合检测血清CA19-9、CA242和CEA有助于胰腺癌的早期诊断及分期判断,具有较高的临床价值。     

大肠癌术后腹腔引流液中CEA、CA125和CA19-9的水平及其临床意义

目的 探讨大肠癌术后腹腔引流液中癌胚抗原（CEA）、糖类抗原125（CA125）和糖类抗原19-9（CA19-9）的水平及其与临床分期和腹腔微转移的关系。方法 收集经手术治疗的86例大肠癌患者（大肠癌组）和30例肠道良性疾病患者（对照组）术后第1天的腹腔引流液,检测腹腔引流液中CEA、CA125和CA19-9的水平,并分析其与大肠癌临床病理特征的关系。结果 大肠癌组腹腔引流液的CEA水平高于对照组（P＜0.05）,CA125和CA19-9水平两组差异均无统计学意义（P＞0.05）;腹腔引流液中CA125和CA19 9水平与大肠癌临床病理特征无关（P＞0.05）,而CEA水平与淋巴结转移、浸润深度和临床分期有关。结论 大肠癌术后腹腔引流液CEA检测可用于预测临床分期、腹腔微转移并判断预后。     

外周血内CA19-9、CA242、CEA检测对不同病理分期胰腺癌的临床诊断价值

目的:分析糖类抗原19-9、糖类抗原242、癌胚抗原(CEA)检测对不同病理分期胰腺癌的临床诊断价值。方法:选取我院2015年7月至2017年1月收治的106例胰腺癌患者,检测血清CA19-9、CA242、CEA表达水平,比较手术治疗前后及不同临床分期胰腺癌患者血清CA19-9、CA242、CEA差异,评价上述指标对胰腺癌临床诊断及判断分期的指导作用。结果:胰腺癌病理分期越高,其血清CA19-9、CA242、CEA水平升高越显著,差异有统计学意义（P＜0.05）。肿瘤直径≥5 cm者、肿瘤位于胰腺体/尾部者,其血清CA19-9、CA242、CEA均显著高于肿瘤直径＜5 cm者及肿瘤位于胰腺头部或全胰腺者,差异有统计学意义（P＜0.05）。 结论:血清CA19-9、CA242、CEA有助于胰腺癌的临床诊断及分期判断,具有较高的临床价值。     

胃癌患者血清CA72-4、CEA及CA19-9水平及其与临床病理特征的相关性

目的:探讨血清CA72-4、CEA及CA19-9水平与胃癌患者病理特征的相关性。方法:选择2011年6月-2013年3月收治的86例胃癌患者,56例胃良性肿瘤患者,60例普通胃病患者,比较三组患者CA72-4、CA19-9和CEA水平;CA72-4、CA19-9和CEA单项检测及联合检测胃癌患者的阳性率;CA72-4、CA19-9和CEA水平与胃癌病理特征的关系。结果:胃癌组患者血清CA72-4、CA19-9和CEA水平均高于胃良性肿瘤组患者（P＜0.05),胃癌良性组患者均高于对照组（P＜0.05);三种胃癌肿瘤标志物中CA72-4诊断胃癌的阳性率最高,肿瘤3项标志物的阳性检测率要显著高于单项CA72-4、CA19-9、CEA的阳性检出率（P＜0.05）;肿瘤越大、TNM分期越高,CA72-4、CA19-9和CEA水平越高。结论:采用CA72-4、CA19-9和CEA联合检测是诊断胃癌比较理想的组合。CA72-4、CA19-9和CEA水平的变化可以反应胃癌患者的病理特征。     

术前预后营养指数在肝内胆管癌根治性切除术后的预后预测价值

目的:探讨术前预后营养指数（prognostic nutritional index,PNI）在肝内胆管癌根治性切除术后的预后预测价值。方法:回顾性分析2012年1月至2018年12月于我院普通外科因肝内胆管癌行根治性切除术的107例患者的临床病理资料,分析PNI与患者临床病理特征、预后预测价值及其与预后的关系。结果:术前低PNI组与高PNI组患者的临床病理特征分析显示:低PNI组患者中CEA>5.0 ng/mL、CA19-9>39.0 U/mL、Child-Pugh肝功分级呈B级、肿瘤大小>5 cm、T分期呈T3及T4期、N1期比例明显高于高PNI组患者（P＜0.05）。单因素分析显示,PNI是影响患者预后的危险因素（P＜0.05）。多因素分析显示,PNI是影响患者预后的独立危险因素(P＜0.05)。时间依赖的ROC曲线显示:PNI在预测患者术后的1年、3年及5年总体生存期的AUC分别为67.93%、70.44%及68.32%。对独立危险因素分层分析发现:CEA≤5.0 ng/mL、CA19-9≤39.0 U/mL、CA19-9>39.0 U/mL及N0患者中低PNI组和高PNI组总体生存时间具有统计学差异（P＜0.05）。结论:术前PNI是肝内胆管癌根治性切除术后的独立危险因素,可用于患者预后预测。术前PNI对于CEA≤5.0 ng/mL、CA19-9≤39.0 U/mL、CA19-9>39.0 U/mL及N0者具有更好的预后预测价值。     

大肠癌血清CEA，CA19-9和CA242联合检测及其临床应用

 目的 评价CEA，CA19-9及CA242联合检测对大肠癌患者的临床诊断价值。方法 应用酶联免疫法对术前150例，其中术后70例大肠癌患者和200名健康人血清CEA，CA19-9及CA242含量进行测定。结果 大肠癌患者血清3项标志物含量明显高于健康人（均P＜0.01）；单项和联合检测的阳性率及特异性总体比较差异均有统计学意义（均P＜0.01）；其中CEA、CA242 检测的阳性率显著高于CA19-9， CEA+CA242与3项联合检测的阳性率均显著高于单项或其他两项联合检测的阳性率；CEA特异性高于CA242；3项联合检测的特异性明显低于单项检测。3个年龄段大肠癌患者CEA血清水平差异显著，年龄越大CEA水平越高（P＜0.05）。在Dukes 分期中，3项标志物含量及检测的阳性率依次增高（P＜0.05～0.01）。淋巴结转移患者的3项标志物含量及CA19-9，CA242的阳性率均高于无淋巴结转移的患者。3项标志物含量随肿瘤侵袭程度的加深显著增高，但在组织病理分类和肿瘤大体形态中均无明显的差异。Dukes A+B期大肠癌术后3项标志物含量显著降低（P＜0.01），而C+D期改变不明显。结论 3项标志物的检测有助于大肠癌的临床辅助诊断，联合检测可以提高诊断的阳性率；3项标志物检测对大肠癌临床分期、淋巴结转移及肿瘤侵犯程度评估，尤其CA19-9和CA242比用于术前诊断更有意义，对指导临床医师合理手术有一定的帮助；术后检测有助于观察疗效，评价治疗效果。     

联合检测血清 CEA、CA50、CA19-9、CA125水平在胃癌诊断中的价值

目的：探讨联合检测血清癌胚抗原（CEA）、糖类抗原125（CA125）、糖类抗原50（CA50）、糖类抗原19-9（CA19-9）水平在胃癌诊断中的临床价值。方法采用放射免疫分析法检测56例经病理学确诊的胃癌患者和48例胃部良性疾病患者血清 CEA、CA50、CA19-9、CA125水平,并收集30例正常健康体检者作比较作为正常对照。结果胃癌患者术前血清 CEA、CA50、CA19-9、CA125水平明显高于胃部良性疾病患者及正常健康体检者（P 均＜005）;胃部良性疾病患者及正常健康体检者血清 EA、CA50、CA19-9、CA125水平比较差异均无统计学意义（P 均＞005）。胃癌患者术后3个月血清 CEA、CA50、CA19-9、CA125水平明显低于术前（P 均＜005）。联合检测 CEA、CA50、CA19-9、CA125的敏感性为875%,明显高于任一单项检测（P 均＜005）。复发胃癌患者血清CEA、CA50、CA19-9、CA125水平明显高于未复发患者（P 均＜005）。结论联合检测血清CEA、CA50、CA19-9、CA125水平可以提高胃癌患者诊断的敏感性,有助于胃癌的诊断、治疗方案选择及预后评估。     

结直肠癌患者的血清血管内皮生长因子结直肠癌患者的血清血管内皮生长因子、糖类抗原19-9、癌胚抗原水平及与临床特征和预后的关系

目的 探讨结直肠癌患者的血清血管内皮生长因子（VEGF）、糖类抗原19-9(CA19-9)、癌胚抗原（CEA）水平及与临床特征和预后的关系。方法 选取80例结直肠癌患者和80例健康体检者,分别作为观察组和对照组。比较两组受试者的血清VEGF、CA19-9、CEA水平,比较不同临床特征结直肠癌患者的VEGF、CA19-9、CEA阳性率。对结直肠癌患者随访1年,根据预后情况分为死亡组、生存组。比较死亡组和生存组患者的血清VEGF、CA19-9、CEA水平及卡氏功能状态（KPS）评分。采用Spearman相关分析法分析结直肠癌患者血清VEGF、CA19-9、CEA水平与KPS评分的相关性。结果 观察组患者的血清VEGF、CA19-9、CEA水平均明显高于对照组,差异均有统计学意义（P﹤0.01）。不同分化程度、TNM分期、淋巴结转移情况结直肠癌患者的VEGF、CA19-9、CEA阳性率比较,差异均有统计学意义（P﹤0.01）。随访1年,死亡22例,生存58例。死亡组患者的血清VEGF、CA19-9、CEA水平均明显高于生存组,KPS评分明显低于生存组,差异均有统计学意义（P﹤0.01）。结直...     

癌胚抗原和糖类抗原19-9对Ⅱ~Ⅲ期结肠癌复发的预测价值

背景与目的：Ⅱ~Ⅲ期结直肠癌患者根治术后约有1/3出现复发转移,影响患者预后。该研究旨在评估癌胚抗原（carcinoembryonic antigen,CEA）和糖类抗原19-9（carbohydrate antigen 19-9,CA19-9）对Ⅱ~Ⅲ期结肠癌患者根治术后复发的预测价值。方法：回顾性分析2012—2013年收治的168例Ⅱ~Ⅲ期结肠癌患者的临床病理和随访资料,均接受根治术,根据术前和术后血清CEA和CA19-9结果将患者分成3组。结果：CEA（H）组的无复发生存率显著低于CEA（HN）组和CEA（N）组（7.4% vs 52.5% vs 75.0%,P=0.000）,CA19-9（H）组的无复发生存率显著低于CA19-9（HN）组和CA19-9（N）组（7.1% vs 50.0% vs 61.9%,P=0.000）;COX比例风险回归模型多因素分析显示,CEA（H）组、CEA（HN）组、CA19-9（H）组及淋巴结转移是Ⅱ~Ⅲ期结肠癌根治术后复发的独立危险因素。结论：血清CEA和CA19-9可以作为Ⅱ~Ⅲ期结肠癌患者预测复发、协助TNM分期判断预后的重要指标。     

胰头癌根治术后患者预后相关因素分析

目的:探讨影响胰头癌根治性切除病人术后生存的相关因素。方法:回顾性分析2012年1月至2015年12月中国医科大学附属盛京医院111例行根治性手术切除的胰头癌患者的临床病理资料和随访资料。结果:111例患者术后中位生存时间12.1个月,1、3、5 年生存率分别为52.3%、20.6%、10.8%。单因素分析显示,年龄、术前CA19-9水平、被膜外浸润、肿瘤大小、淋巴结转移、肿瘤分化程度、肿瘤分期、胰腺切缘、术后是否化疗为影响胰头癌预后的因素（P＜0.05）。COX多因素分析显示,术前CA19-9水平、肿瘤分化程度、淋巴结转移、被膜外浸润、肿瘤大小、术后是否化疗及胰腺切缘为胰头癌患者预后的独立影响因素（P＜0.05）。结论:肿瘤分化水平差、淋巴结转移、肿瘤直径大于等于4 cm、未达到R0切除的胰头癌患者预后较差,根治性手术术后联合化疗可明显延长胰头癌病人的生存时间。     

Prognostic value of preoperative serum tumor markers in gastric cancer

AIM: To evaluate the prognostic value of preoperative carcinoembryonic antigen (CEA), carbohydrate antigen (CA)19-9, and CA50 in patients undergoing D2 resection.METHODS: We evaluated 363 patients with gastric cancer who underwent gastrectomy at our hospital from January 2006 to December 2009. Blood samples were obtained from each patient within 1 wk before surgery. The cut-off values for serum CEA, CA19-9, and CA50 were 5 ng/mL, 37 U/mL, and 20 U/mL, respectively. The correlation between preoperative tumor marker levels and prognosis was studied by means of univariate and multivariate analyses.RESULTS: The preoperative serum positive rates of CEA, CA19-9 and CA50 were 24.0%, 18.9% and 24.5%, respectively. The positivity rate of serum CEA was significantly correlated with age (P < 0.001), sex (P = 0.022), tumor size (P = 0.007) and depth of invasion (P = 0.018); CA19-9 with tumor size (P = 0.042) and lymph node metastasis (P < 0.001); and CA50 only with lymph node metastasis (P = 0.001). In multivariate analysis, tumor size, T category, N category, vascular or neural invasion, and adjuvant chemotherapy were independent prognostic factors for overall survival. CA19-9 had an independent prognostic significance in patients without adjuvant chemotherapy (P = 0.027).CONCLUSION: Preoperative serum CEA, CA19-9 and CA50 are prognostic in patients with gastric cancer. Only CA19-9 is an independent prognostic factor after surgery without adjuvant chemotherapy.     

原发性乳腺癌患者术前血清中糖类抗原153癌胚抗原和组织多肽特异性抗原水平与临床病理特征和预后的关系

目的 探讨原发性乳腺癌患者术前血清中糖类抗原153( CA153)、癌胚抗原(CEA)和组织多肽特异性抗原(TPS)水平与患者临床病理特征和预后的关系.方法 对386例Ⅰ～Ⅳ期原发性乳腺癌患者的临床资料进行严格随访,回顾性分析患者术前血清中CA153、CEA和TPS水平与乳腺癌临床病理特征和预后的关系.结果 分别有383、382和324例患者进行了术前CA153、CEA和TPS的检测,平均表达水平分别为(21.46±34.88)U/ml、(1.53±7.95)μg/L和(224.87±436.19) AU/ml,CA153、CEA和TPS的阳性表达率分别为10.7％ (41/383)、7.6％ (29/382)和63.9％ (207/324).原发性乳腺癌患者术前血清CA153的表达水平与患者的年龄和肿瘤大小显著相关(均P＜0.05),CEA的表达水平与肿瘤大小显著相关(P＜0.05),TPS的表达水平与肿瘤大小和淋巴结转移状况显著相关(均P＜0.05).术前血清CA153、CEA和TPS阳性表达患者的总生存率显著低于阴性患者(均P＜0.05).Cox多因素分析表明,ER的表达水平以及术前CA153的表达水平是影响乳腺癌患者预后的独立因素(均P＜0.05),其中术前CA153水平增高是危险因素,而ER阳性表达则是保护因素.结论 术前血清CA153、CEA和TPS的表达水平与乳腺癌患者的临床病理特征和预后有关,CA153是影响乳腺癌患者预后的独立因素,CA153表达水平增高者的预后较差.     

The prognostic significance of preoperative serum CA 19-9 in patients with resectable gastric carcinoma: comparison with CEA

BACKGROUND AND OBJECTIVES: In this study, the prognostic value of pre-operative serum levels of tumor markers CA 19-9 and carcinoembryonic antigen (CEA) in gastric carcinoma which has been a controversial matter was investigated. METHODS: Preoperative serum CA 19-9 (cut-off value 37 U/ml) and CEA (cut-off value 5 ng/ml) levels were measured in 168 patients with resectable gastric carcinoma. The correlation between tumor marker levels and clinicopathological features and overall survival was studied. RESULTS: CA 19-9 and CEA positivity rates were 31.5 and 17.8% respectively. In CA 19-9 positive patients, the ratio of males, tumors exceeding subserosa and advanced stage tumors (stages III and IV) was significantly higher (P = 0.052, P = 0.0005 and P= 0.029, respectively). A weak correlation was found with CA 19-9 positivity and tumor location; however, no correlation existed between CA 19-9 positivity and age, tumor size, histologic type, lymph node, hepatic and peritoneal metastasis. The proportion of tumors extending beyond subserosa and with lymph node metastasis was significantly higher in CEA positive patients (P = 0.011 and P = 0.045, respectively). No correlation was found between CEA positivity and gender, age, tumor location, tumor size, and hepatic and peritoneal metastasis; however, a weak correlation existed between CEA positivity and histologic type and tumor stage. Overall survival was significantly poorer in CA 19-9 and CEA positive patients (log-rank test, P = 0.014, P = 0.003, respectively). However, the Cox proportional hazards regression analysis did not show independent prognostic value for both tumor markers. CONCLUSIONS: In resectable gastric carcinoma, preoperative serum CA 19-9 and CEA levels may indicate stage of the disease, but neither has an independent prognostic value.     

DAPK蛋白、Ki-67蛋白在子宫内膜癌中的表达及其与临床病理学特征的相关性

目的:探讨DAPK蛋白、Ki-67蛋白在子宫内膜癌中的表达及其与临床病理学特征的相关性。方法:选取2012年6月至2016年10月在我院及邯郸市第一医院治疗的子宫内膜癌患者150例,同时选取150例子宫内膜增生患者,采用免疫组化法检测DAPK蛋白、Ki-67蛋白表达情况,采用全自动生化法检测血清中CEA、CA19-9和CA125等的表达,分析 DAPK蛋白、Ki-67蛋白的表达与子宫内膜癌临床病理特征的关系。结果:子宫内膜癌患者组织中的DAPK蛋白低于子宫内膜增生组（P＜0.05）,Ki-67蛋白阳性表达率均高于子宫内膜增生组患者（P＜0.05）;子宫内膜癌组患者CEA、CA19-9和CA125水平均高于子宫内膜增生组（P＜0.05）;子宫内膜癌患者的DAPK阳性表达率与CEA等肿瘤标志物水平负相关（P＜0.05）,子宫内膜癌患者的Ki-67阳性表达率与CEA等肿瘤标志物水平正相关（P＜0.05）;不同年龄的患者间DAPK、Ki-67的表达无差异,高分化、无淋巴结转移、TNM分期为Ⅰ+Ⅱ期的子宫内膜癌患者的DAPK阳性表达率较高（P＜0.05）,高分化、无淋巴结转移、TNM分期为Ⅰ+Ⅱ期的子宫内膜癌患者的Ki-67阳性表达率较低（P＜0.05）。结论:DAPK蛋白、Ki-67蛋白在子宫内膜癌患者中存在异常表达,且其表达与患者的病情或者细胞分化、淋巴结转移等具有密切关系。     

肿瘤标记物CA19-9、CA242对胰腺癌转移和预后预测价值的分析

目的:探讨肿瘤标记物糖类抗原19-9(CA19-9)、糖类抗原242(CA242)对胰腺癌转移和预后的预测价值.方法:选取80例胰腺癌患者和20例健康人群的血清样本,测定血清中CA19-9、CA242水平.探讨两者与胰腺癌临床分期、分型、肿瘤大小、淋巴转移情况和预后的关系.结果:胰腺癌患者血清CA19-9、CA242水平显著高于健康人群(P＜0.01).胰腺癌患者中Ⅲ+ Ⅳ期患者血清CA19-9、CA242水平显著高于Ⅰ+Ⅱ期患者(P＜0.05),淋巴转移患者血清CA19-9、CA242水平显著高于无转移患者(P＜0.05),生存期小于8个月患者血清CA19-9、CA242水平显著高于大于8个月患者(P＜0.05).以CA19-9 37.0U/ml、CA242 20.0U/ml为阳性阈值,以CA19-9阳性且CA242阳性组的正确指数最高.结论:胰腺癌患者血清CA19-9、CA242水平对胰腺癌患者术前诊断和预后分析具有一定参考价值.     

Evaluation of serum CEA and CA19-9 levels as prognostic factors in patients with gastric cancer

Background. This clinicopathological study evaluated the utility of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 as predictors of locoregional recurrence and long-term disease-free survival in patients with gastric cancer. Methods. During the period January 1989 to December 1994, 485 patients with primary gastric cancer were evaluated. Gastrectomies were performed in 434 patients. Prognostic factors were analyzed by the Kaplan-Meier method and multivariate analysis, using Cox regression. Results. Elevated serum CEA and CA19-9 levels were observed in 92 of the 485 patients (19.0%), and in 95 of the 435 patients (21.8%), respectively, and both markers were elevated in 29 of these 435 patients (6.7%). Elevated serum CEA and CA19-9 levels correlated well with lymph node metastasis, lymphatic invasion, vessel invasion, stage grouping, depth of invasion, and curability. Patients with elevated serum CEA levels were at significantly higher risk of having all recurrence factors than were those with normal serum CEA levels. Patients with elevated serum CA19-9 levels were at significantly higher risk of having peritoneal metastases and distant metastases than were those with normal serum CA19-9 levels. A significant difference in the cumulative survival curves of patients was demonstrated between those with elevated and those with normal serum CEA or CA19-9 levels, even for patients at the same disease stage (stage III). Patients with elevated levels of both markers had a significantly worse prognosis than patients in whom the levels of both markers were normal. In patients who underwent gastrectomy, elevated serum CEA levels either preoperatively or within 3 weeks after gastrectomy were associated with significantly worse prognosis than were normal levels. When the cutoff level of serum CEA was increased to 10 ng/ml, serum CEA, age, lymph node metastasis, and surgical stage grouping were selected as independent prognostic factors by multivariate analysis of 14 prognostic factors, using Cox regression. Conclusion. Serum CEA and CA19-9 levels provide additional prognostic information in patients with primary gastric cancer. In particular, an elevated serum CEA level provides additional prognostic information and is a useful indicator of curability in patients who undergo gastrectomy. Serum CEA level is an independent prognostic factor in patients with primary gastric cancer. Received: June 20, 2000 / Accepted: November 14, 2000