胃癌术后随访中CEA和CA19-9联合检测的临床意义

目的:探讨血清CEA和CA19-9联合检测对胃癌根治术后有无复发和(或)转移的诊断实用价值.方法:57例胃癌患者,在根治术后第1年的每2个月,第2年的每3个月、第3年的每6个月、第4～5年中的每1年均分别作血清CEA及CA19-9联合检测;术后第1年,每半年作一次胃镜、腹部B超、胸片检查,以后的2～5年,每年作一次胃镜、腹部B超、胸片检查.凡血清CEA及(或)CA19-9阳性者即作胃镜及(或)肠镜、腹部B超、胸片等相关检查.凡胃镜及腹部B超等检查提示复发或转移者、有腹部不适、大便性状改变、食欲下降、体重减轻等症状者即作血清CEA及CA19-9检查.结果:34例被证实复发及(或)转移.其中CEA及CA19-9检测的阳性率分别为44.12%和58.82%;CEA和CA19-9同时检测,对胃癌复发和(或)转移的总发现率为85.29%.检查证实有局部复发和(或)转移者,大多与肝、胆、胰转移有关.结论:血清CEA和CA19-9联合检测,可明显弥补单项检测的不足,可提高对胃癌术后复发及转移的发现率.     

联合检测血清CA72-4、CA19-9和CEA对胃癌临床价值的探讨

目的：探讨血清ＣＡ７２－４、ＣＡ１９－９、ＣＥＡ联合检测对胃癌的临床价值。方法：对３２例中晚期胃癌患者和２１例良性胃病患者采用放射免疫法（ＲＩＡ）分析测定ＣＡ７２－４、ＣＡ１９－９和ＣＥＡ,结果：胃癌组中ＣＡ７２－４、ＣＡ１９－９、ＣＥＡ血清测定值水平,阳性率均明显高于良性胃病组（Ｐ〈０．０１）。其中胃癌组的ＣＡ７２－４阳性率（５９．４％）明显高于ＣＡ１９－９和ＣＥＡ（２８．１％）。联合检测时胃癌     

大肠癌患者血清CA242、CA19-9和CEA水平测定的临床意义

目的：评价CA242、CA19-9和CEA在大肠癌诊断中的意义。方法：采用酶联免疫和放射免疫法分别检测40例健康人、42例炎性肠病患者和74例大肠癌患者CA242、CA19-9和CEA的含量。结果：大肠癌患者CA242、CA19-9和CEA抗原表达均分别高于健康人和炎性肠病患者。具有显著性差异。其中CA242特异性最好，为89．42％。在大肠癌患者中CA19-9检出率最高。为83．78％。CA242、CA19-9分别在结肠癌和直肠癌中的表达水平不同。其差异具有显著性意义。结论：血清CA242、CA19-9和CEA的联合检测有利于大肠癌的早期诊断，也可作为大肠癌治疗药物疗效评价的重要依据。     

CEA和 CA19-9在结直肠癌组织中的表达及临床意义

目的：探讨CEA和CA19-9在结直肠癌中的表达及其与临床病理参数和预后的关系。方法采用免疫组织化学法,检测47例结直肠癌组织中CEA和CA19-9的表达,并分析两者表达与其临床病理参数和预后的关系。结果CEA和CA19-9蛋白在结直肠癌组织中呈高表达。 CEA表达与M分期显著相关,与其他临床参数无相关性。 CA19-9表达与性别、年龄、T期、N期、M期、Duke分期及肿瘤大小无相关性。 CEA和CA19-9蛋白在结直肠癌组织中的表达与其生存期无相关性,但CEA和CA19-9联合检测一定程度上可预测预后。结论 CEA表达与结直肠癌M分期显著相关, CEA和CA19-9联合检测有助于预测结直肠癌患者预后。     

大肠癌血清CEA,CA19-9和CA242联合检测及其临床意义

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150例术前大肠癌患者及其中70例术后患者和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增加显著增高，但在组织病理分类和肿瘤大体形态中均差异无统计学意义。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。     

胃癌术后随访中CEA和CA19-9联合检测的临床意义

目的：探讨血清CEA和CA19-9联合检测对胃癌根治术后有无复发和(或)转移的诊断实用价值。方法：57例胃癌患者，在根治术后第1年的每2个月，第2年的每3个月、第3年的每6个月、第4∽5年中的每1年均分别作血清CEA及CA19-99联合检测；术后第1年，每半年作一次胃镜、腹部B超、胸片检查，以后的2∽5年，每年作一次胃镜、腹部B超、胸片检查。凡血清CEA及(或)12A19-9阳性者即作胃镜及(或)肠镜、腹部B超、胸片等相关检查。凡胃镜及腹部B超等检查提示复发或转移者、有腹部不适、大便性状改变、食欲下降、体重减轻等症状者即作血清CEA及CA19-9检查。结果：34例被证实复发及(或)转移。其中CEA及CA19-9检测的阳性率分别为44．12％和58．82％；CEA和CA19-9同时检测，对胃癌复发和(或)转移的总发现率为85．29％。检查证实有局部复发和(或)转移者，大多与肝、胆、胰转移有关。结论：血清CEA和CA19-9联合检测，可明显弥补单项检测的不足，可提高对胃癌术后复发及转移的发现率。     

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。     

血清肿瘤标志物CEA、CA19-9对结直肠癌的诊断价值

目的 分析血清肿瘤标志物CEA、CA19-9单项或联合检测对结直肠癌患者的临床诊断价值,探讨其在病理分期、淋巴结转移等临床特征方面的意义.方法 酶联免疫法检测160例健康人和158例结直肠癌患者术前两天以及术后两周血清中CEA、CA19-9含量.结果 结直肠癌患者2种血清肿瘤标志物含量明显高于健康人(P<0.01),术前与术后2种血清肿瘤标志物水平比较差异有统计学意义(P<0.05).CEA、CA19-9联合检测敏感度和特异度明显高于各单项检测值.在Dukes A、B、C及D期中,2种肿瘤标志物含量及检测阳性率依次增高,淋巴结转移患者的CA19-9含量高于无淋巴结转移患者(P<0.05).结论 肿瘤标志物CEA、CA19-9联合检测可以提高结直肠癌诊断的敏感度和特异度,并对临床分期、判断淋巴结转移、预测预后及监测复发有一定的指导意义.     

血清脂联素、CEA、CA19-9、CA72-4联合检测在胃癌早期筛查中的临床价值分析

目的:探讨血清脂联素、CEA、CA19-9、CA72-4联合检测在胃癌早期筛查中的临床价值。方法:选取首次确诊的早期胃癌患者60例,胃癌患者再根据幽门螺杆菌是否感染分为感染组32例与未感染组28例;胃良性疾病组患者100例;健康对照组110例。采用化学发光法检测CEA、CA19-9、CA72-4水平,ELISA检测血清脂联素水平,幽门螺杆菌检测采用C14呼气试验,比较不同分组间各指标的差异。结果:胃癌组血清CEA、CA19-9、CA72-4水平均高于胃良性疾病组和健康对照组(P<0.01),血清脂联素水平显著低于胃良性疾病组和健康对照组(P<0.01);胃癌患者幽门螺杆菌感染时,血清CEA、CA19-9、CA72-4水平明显高于未感染组(P<0.01),感染组患者血清脂联素水平与未感染组比较,无显著性差异(P>0.05);四项联合检测胃癌灵敏度最高,达96.67,特异度为98.10%,阳性预测值为93.55%,阴性预测值为99.04%,阳性似然比为50.75、阴性似然比为0.03,约登指数达0.95,ROC曲线下面积为0.955。结论:胃癌早期患者血清脂联素水平不受幽门螺杆菌感染的影响,四项联合检测可明显提高检测的灵敏度和特异度,对胃癌患者早期筛查具有较高的临床应用价值。     

血清CA125、CA19-9、CEA的检测在大肠癌诊断及治疗中的意义

目的探讨血清CA125、CA199、CEA的检测在大肠癌诊断及治疗中的价值。方法82例大肠癌病人均于2004年6月～2005年6月收治并手术,同时选取41例正常人做为对照组。以蛋白芯片法测定两组血清中CA125、CA199、CEA含量。结果三项指标定量检测大肠癌组明显高于对照组。其阳性率与部位、大体类型、组织类型无明显相关。三项指标阳性率Duke'sC+D期明显高于Duke'sA+B期。CA125、CA199、CEA三项指标敏感度分别为34.1%、34.1%、30.5%,特异度均为97.6%,三项联检敏感度为58.5%,特异度为92.7%,而在Duke'sC+D期,三项联检敏感度为86.8%,特异度为92.7%。结论血清CA125、CA199、CEA的检测对于大肠癌的诊断价值较低,但三项联检在Duke'sC、D期大肠癌病人诊断价值较高,有助于判断大肠癌病理分期并指导手术范围。     

联合检测CEA、CA19-9在D2胃癌术后随访中的价值

目的：探讨联合检测血清肿瘤标志物癌胚抗原（ CEA）和糖类抗原19-9（ CA19-9）在D2胃癌术后患者随访中的应用价值。方法：采集271例D2胃癌术后病人血清,利用免疫荧光分析法检测血清中CEA和CA19-9含量,并根据检验结果划分为CEA（-）/CA19-9（-）、CEA（﹢）/CA19-9（-）、CEA（-）/CA19-9（﹢）和CEA（﹢）/CA19-9（﹢）四个组。采用Kaplan-meier法进行生存率分析,利用Log-rank检验进行统计学差异性比较,χ2检验进行组间单因素分析。结果：两种肿瘤标志物CEA和CA19-9的联合检测时,两个同时为阳性组患者生存期远远低于单一阳性组;CEA（﹢）/CA19-9（-）组与CEA（-）/CA19-9（﹢）组比较,CEA（-）/CA19-9（﹢）组患者生存期要低于对照组,具有统计学差异（ P＜0.05）。结论：联合检测血清肿瘤标志物CEA和CA19-9在D2胃癌术后患者随访中,CA19-9阳性者提示更差的预后。     

血清CEA、CA19-9、CA724检测对老年胃癌病理、临床分期的意义

目的:探讨血清CEA、CA19-9、CA724对老年胃癌的临床应用价值.方法:采用ELISA方法对87例老年胃癌患者进行回顾性分析.结果:老年胃癌患者CEA、CA19-9、CA724阳性率分别为25%、21%、21%,联合检测阳性率为41%,其中TNM Ⅳ期患者CA19-9、CA724、联合检测阳性率明显高于TNM Ⅰ+Ⅱ期患者.TNM Ⅲ+Ⅳ期患者CA19-9、CA724检测值明显高于Ⅰ+Ⅱ期患者.CEA、CA19-9、CA724阳性率、其值大小与胃癌病理类型、分化无关.结论:CEA、CA19-9、CA724可用于老年胃癌的诊断、病情判断,联合检测可提高诊断效率,但早期诊断价值有限.     

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     

血清CEA、CA19—9、CA724检测对老年胃癌病理、临床分期的意义

目的：探讨血清CEA、CA19—9、CA724对老年胃癌的临床应用价值。方法：采用ELISA方法对87例老年胃癌患者进行回顾性分析。结果：老年胃癌患者CEA、CA19—9、CA724阳性率分别为25％、21％、21％,联合检测阳性率为41％,其中TNMIV期患者CA19—9、CA724、联合检测阳性率明显高于TNMⅠ＋Ⅱ期患者。TNMⅢ＋Ⅳ期患者CA19—9、CA724检测值明显高于Ⅰ＋Ⅱ期患者。CEA、CA19—9、CA724阳性率、其值大小与胃癌病理类型、分化无关。结论：CEA、CA19—9、CA724可用于老年胃癌的诊断、病情判断,联合检测可提高诊断效率,但早期诊断价值有限。     

CEA,CA19—9,CA50联合检测对胃肠道肿瘤的诊断价值

采用放射免疫法检测４１例胃肠恶性肿瘤和２０名健康人血清癌胚抗原（ＣＥＡ），糖链抗原（ＣＡ１９－９、ＣＡ５０）含量，并与癌组织学分类、有无淋巴结转移对比分析。结果显示：胃肠肿瘤ＣＥＡ、ＣＡ１９－９、ＣＡ５０值明显高于对照组（Ｐ〈０．０１）。胃癌伴肝、胰转移时ＣＡ１９－９增高尤其显著，胃癌ＣＡ５０值高于大肠癌（Ｐ〈０．０５）。胃肠肿瘤淋巴结转移者三项指标检出率较无转移者高，但差异无显著性。病理分类中胃     

血清肿瘤标志物CEA、CA19-9和CA72-4在胃癌术后监测中的意义

目的研究血清肿瘤标志物CEA、CA19—9和CA72—4在胃癌术后复发、转移监测中的意义。方法采用电化学发光法检测228例手术后胃癌患者血清CEA、CA19—9和CA72—4含量;并结合临床及随访资料进行分析。结果胃癌术后复发、转移患者CEA、CA19—9和CA72—4的含量和阳性率均显著高于未发生复发、转移患者。术后复发、转移的胃癌患者血清CEA、CA19—9和CA72—4检测灵敏度和特异度分别为46．2％和94．7％,52．3％和97．4％,47．1％和90．6％。结论血清CEA、CA19—9和CA72-4升高与胃癌复发、转移密切相关,在术后随访过程中检测血清肿瘤标志物有助于早期诊断胃癌复发、转移。     

The usefulness of CEA and/or CA19-9 in monitoring for recurrence in gastric cancer patients: a prospective clinical study

Background. Many studies on postoperative carcinoembryonic antigen (CEA) and/or carbohydrate antigen (CA)19-9 monitoring after operation for gastric cancer have been reported, but most have been retrospective. Methods. A nationwide observational study was implemented in 135 leading institutions in Japan to evaluate the significance of CEA and/or CA19-9 in postoperative monitoring for recurrence in patients with advanced gastric cancer. Three hundred and twenty-one patients examined in this analysis underwent radical gastrectomy at one of Japan's leading institutions between November 1993 and March 1996 and had been followed up for at least 5 years. Serum levels of CEA and CA19-9 were examined preoperatively and every 3 months postoperatively, with diagnostic imagings, such as chest X-ray, computed tomography (CT), and ultrasonography also being performed every 3 months. Results. Recurrence was observed in 120 patients (peritoneum, 48; liver 16; lymph node, 16; multiple sites, 25; and others, 12). Sensitivities of CEA and either CEA or CA19-9, or both, for recurrence were 65.8% and 85.0%, respectively, both of which values were significantly higher than the preoperative positivities (28.3% and 45.0%, respectively). In most patients with high preoperative levels CEA and/or CA19-9, these tumor markers increased again at recurrence. Recurrent diseases were detected between 5 months after detection by diagnostic imagings and 12 months before detection by diagnostic imagings (mean of 3.1 ± 3.6 months before detection by diagnostic imagings) and between 10 months after detection by diagnostic imagings and 13 months before detection by diagnostic imagings (mean of 2.2 ± 3.9 months before detection by diagnostic imagings) by CEA and CA19-9 monitorings, respectively. Conclusion. These results suggest that CEA and/or CA19-9 monitoring after operation was useful to predict the recurrence of gastric cancer, especially in almost all the patients with high preoperative levels of these markers.We reported this study at the poster session of the eighteenth meeting of the American Society of Clinical Oncology.     

PET-CT在结直肠癌术后CEA、CA19-9升高患者中的应用

 目的　探讨18F-脱氧葡萄糖（18F-FDG）正电子发射式断层CT（PET-CT）显像在结直肠癌术后CEA、CA19-9升高患者的临床应用价值。方法　对87例结直肠癌术后CEA、CA19-9升高患者行全身18F-FDG PET-CT显像,图像采用视觉和半定量分析,所有病例最终确诊依据为再次手术病理结果、多种影像学检查或临床随访证实,将显像结果与临床随访所作出的诊断进行比较。结果　87例结直肠癌术后CEA、CA19-9升高患者,18F-FDG PET-CT诊断肿瘤复发转移的灵敏度为91 %（71／78）,特异度为66.7 %（6／9）,准确度为88.5 %（77／87）。61例患者近期（3个月内）有胸部、腹部和盆腔的传统影像学（B型超声、CT、MRI）检查,其中32例患者18F-FDG PET-CT显像发现了传统影像学未发现的病灶或病灶较传统影像学广泛,临床对其中21例患者的治疗方案进行了修正,修正率为34.4 %（21／61）。结论　18F-FDG PET-CT显像对结直肠癌术后CEA、CA19-9升高患者诊断肿瘤复发、寻找转移病灶及准确判定术后再分期等方面有较大的临床应用价值。