组织和血清癌胚抗原含量比值对大肠癌的诊断意义

应用放射免疫法测定活检组织及血清的组织癌胚抗原（CEA）含量，评价CEA含量对大肠癌的诊断价值。16例大肠癌患者同时测定病变组织（1组）、癌旁组织（2组）及其血清（4组）的CEA含量，并设31例非大肠癌患者大肠组织（3组）及其血清（5组）的CEA含量为对照。结果显示1组和其他四组比较有显著性差异（P〈0．01）。组织CEA含量／自身血清CEA含量〉8为阳性，则1组、2组、3组的阳性率分别为75．00％、0、12．90％；1组与另两组间比较均有显著性差异（P〈0．01）。另外大肠癌的血清CEA异常升高的比率为5．88％。本文结果提示对大肠癌患者测定活检组织中CEA含量明显优于血清的CEA测定。组织与血清CEA含量比值的明显增高对大肠癌的诊断呵提供佐证。     

老年肿瘤患者血清促红细胞生成素变化及其与化疗的关系

目的 分析老年肿瘤患者血清促红细胞生成素(Epo)水平及其与血红蛋白(Hb)的关系,以及化疗对其的影响. 方法 应用ELISA方法 检测老年肿瘤患者血清Epo,并观察化疗后Epo变化. 结果 (1)老年组Epo为(22.0±15.1)U/L,与对照组(30.4±21.8)U/L比较,差异无统计学意义(t=1.2988,P＞0.05);Epo水平与Hb水平存在负相关关系(r=0.3700,P＜0.01);(2)55例Hb正常者Epo为(14.7±10.6)U/L,22例轻度贫血者(20.2±9.O)U/L,23例中重度贫血者(42.3±24.8)U/L,差异有统计学意义(F=11.6886,P＜0.01);(3)化疗4周期和2周期后,贫血组Epo分别为(45.2±39.1)U/L和(25.8±15.9)U/L,与治疗前的(20.2±10.8)U/L比较,差异有统计学意义(F=4.5477,PG0.01);Hb分别为(96.8±16.6)g/L和(102.1±19.3)g/L,与治疗前的(111.0±20.5)g/L比较,差异有统计学意义(F=4.0071,PG0.01). 结论 老年肿瘤患者与非老年肿瘤患者比较,Epo水平差异无统计学意义;贫血患者Epo水平明显高于无贫血患者;Epo水平与Hb值呈负相关关系;化疗可以引起部分患者发生贫血,并且随着化疗周期的增加,Hb值下降而Epo水平升高.     

Significance of a fall in serum CEA concentration in patients treated with cytotoxic chemotherapy for disseminated colorectal cancer.

'Tumour response', defined as clinical or radiological evidence of tumour shrinkage is frequently regarded as an objective of chemotherapy, rather than as a predictor of prolonged survival. This study has assessed whether a fall in the serum CEA concentration after chemotherapy for disseminated colorectal cancer is a predictor of prolonged survival and compared it with tumour response as a predictor of survival. There was a 37% improvement in median survival among patients whose serum CEA concentration fell after chemotherapy (70% of patients treated) compared with patients whose serum CEA did not fall. The use of greater than 25% clinical or radiological tumour shrinkage as a predictor of prolonged survival identified a smaller proportion (36%) of patients in whom there was a 52% prolongation in median survival compared with patients whose tumours shrank less than 25%, or did not shrink. Proportional hazards regression analysis suggested that tumour shrinkage was a stronger predictor of survival. A fall in serum CEA concentration, however, identified a group of patients whose tumours did not shrink, but who had a 27% improvement in median survival compared with those whose tumours did not shrink and whose serum CEA concentration did not fall. Monitoring of the serum CEA during the first two months of treatment appears to provide a sensitive and economical means of identifying those patients whose survival is likely to be prolonged by chemotherapy for colorectal cancer.     

结直肠癌AIM2和血清CEA表达水平及其临床意义

目的探讨结直肠癌患者黑色素瘤缺乏因子2（AIM2）和血清癌胚抗原（CEA）表达水平及其临床意义。 方法收集辽宁省肿瘤医院2010年1月~2013年3月118例结直肠癌患者的肿瘤组织标本及其50例癌旁正常组织标本,采用免疫组织化学法测定组织中AIM2的表达,回顾性搜集患者临床病理参数及术前通过电化学发光法（ECUA）测定的血清CEA水平。通过相关性分析癌组织中AIM2表达水平和血清CEA水平的相关性,分析两种指标与临床病理参数的关系。采用Kaplan-Meier法对不同AIM2、CEA水平组别进行生存分析。 结果118例肿瘤组织中有42例AIM2呈高表达,有39例癌旁正常组织呈高表达,差异具有统计学意义（χ²=25.295,P<0.001）;结直肠癌患者术前血清CEA阳性率为44.07%（52/118）。Spearman等级相关性分析结果显示,结直肠癌组织AIM2和血清CEA表达呈负相关（r=-0.660,P<0.001）。肿瘤的浸润深度、TNM分期以及淋巴结转移是影响癌组织AIM2表达水平的相关因素（χ²=4.847,7.794,3.961;均P<0.05）;肿瘤大小、TNM分期以及分化程度是影响患者术前血清CEA水平的相关因素（χ²=17.14,5.779,5.293;均P<0.05）。K-M生存分析显示,AIM2高表达组生存时间明显长于低表达组,术前CEA阴性组生存时间明显长于阳性组,AIM2高表达联合CEA阴性患者生存时间明显长于AIM2低表达联合CEA阳性患者,差异具有统计学意义。 结论结直肠癌患者AIM2和血清CEA表达可能与结直肠癌的进展有关,联合分析两个指标有助于评估结直肠癌患者预后。     

Multivariate analysis of prognostic determinants for colorectal cancer patients with high preoperative serum CEA levels: prognostic value of postoperative serum CEA levels

High preoperative serum carcinoembryonic antigen (CEA) levels have been well investigated and found to be associated with poor prognosis in patients with colorectal cancer (CRC). However, it has been observed that the outcome varies after curative resection, along with postoperative serum CEA levels; some patients continue to have high postoperative serum CEA levels while postoperative CEA levels return to normal in others. The purpose of this study was to determine the prognostic significance of postoperative serum CEA levels in CRC patients with high preoperative serum CEA levels. Between January 2002 and December 2004, 423 CRC patients underwent operation in our hospital; 181 (42.8%) had high preoperative serum CEA levels and were enrolled in this study. Among the 181 patients, 165 patients had curative resection; the remaining 16 had stage IV disease, so they underwent palliative surgery and were subsequently excluded from analysis. Pre- and postoperative serum CEA levels were measured and analyzed. All patients had curative resection and were divided into two groups according to postoperative serum CEA levels: one group comprised patients with postoperative serum CEA > or = 5 ng/mL (n = 80) and the other group comprised patients with postoperative serum CEA levels < 5 ng/mL (n = 85). Postoperative serum CEA levels were significantly related to location of primary tumors (p = 0.042), lymph node metastases (p = 0.009), TNM stage (p = 0.001), and postoperative relapse (p = 0.004). The results of multivariate analysis showed that both lymph node metastases and high postoperative serum CEA levels (> or = 5 ng/mL) were independent prognostic factors for CRC patients after curative resection. Postoperative serum CEA levels can be a single independent prognostic determinant in CRC patients with high preoperative serum CEA levels. Intensive follow-up and adjuvant therapy may be necessary in CRC patients who continue to have high postoperative serum CEA levels even after curative resection.     

Postoperative chemotherapy in elderly patients with advanced gastric cancer

BACKGROUND/AIMS: The definitive efficacy of postoperative chemotherapy in elderly patients with advanced gastric cancer has not been established. The aim of this study is to evaluate prognosis in elderly patients with advanced gastric cancer and the effect of postoperative chemotherapy on prognosis. METHODOLOGY: Fifty-three patients, 75 years of age or older who underwent curative surgery for advanced gastric cancer were divided into 14 patients with postoperative chemotherapy (chemotherapy group) and 39 patients without postoperative chemotherapy (control group). Chemotherapy regimens were as follows: oral 5-FU alone (n = 11), intravenous mitomycin plus 5-FU: MF (n = 2), and MF plus oral 5-FU (n = 1). No prior chemotherapy or radiation was given. RESULTS: There were no significant differences of clinical and pathological backgrounds between the two groups. The rate of death due to recurrent carcinoma was 50.0% in the chemotherapy group and 43.6% in the control group, the difference being insignificant. Although the median survival time of the chemotherapy group (40.4 months) was longer than in the control group (31.7 months), a significant difference did not exist between the groups. The 1-, 3-, and 5-year survival rates did not significantly differ between the chemotherapy group versus the control group, 85.7% versus 82.1%, 42.9% versus 51.3%, and 35.7% versus 46.2%, respectively. CONCLUSIONS: Postoperative chemotherapy did not contribute to prolong survival in elderly patients with advanced gastric cancer mainly because the incidence of recurrent carcinoma was not reduced.     

老年非小细胞肺癌患者血清褪黑素的变化及其与化疗的关系

目的研究老年非小细胞肺癌(NSCLC)患者血清褪黑素变化及其与化疗的关系。方法将NSCLC患者149例按年龄分为老年组77例和非老年组72例,用高效液相荧光色谱法检测患者血清褪黑素水平,并对比分析化疗前后患者褪黑素、白细胞、血肌酐、尿素氮、T细胞亚群和自然杀伤(NK)细胞的变化。结果老年组与非老年组各项生化指标和T细胞亚群治疗前和治疗后比较差异均无统计学意义;血清褪黑素水平两组治疗前和治疗后各时间点比较差异亦均无统计学意义。老年和非老年组患者中午12:00和夜间00:00褪黑素含量变化均有昼夜节律性;夜间的褪黑素值在化疗前后老年组为32．3±6．5和21．7±9．8,非老年组为43．6±7．9和25．3±8．6,差异均有统计学意义(P<0．05);两组患者化疗前后白细胞、血肌酐的变化,差异均有统计学意义(P<0．05);尿素氮变化差异无统计学意义(P>0．05);患者T细胞亚群在治疗前后两组间的变化差异无统计学意义(P>0．05);NK细胞差异有统计学意义(P<0．01)。结论NSCLC患者随着化疗的进行,夜间褪黑素水平渐进性下降,化疗可能影响人体神经内分泌系统,进而影响了褪黑素的合成。测定夜间血清褪黑素水平对了解NSCLC临床治疗情况、减少不良反应有参考价值。     

New perspectives in colon cancer chemotherapy

Camptothecin and some of its derivatives, all inhibitors of topoisomerase I, have been found to inhibit growth and induce regression of human colon carcinoma xenografts in nude mice. Some clinical trials of these compounds have been already completed, many more are being held. The mother compound, camptothecin, which is water insoluble, has been administered orally in a Phase I clinical trial. Main toxicity encountered has been diarrhea with minimal leukocytopenia. Camptothecin is now in Phase 2 clinical trials. 9-Aminocamptothecin, a water-insoluble derivative, is now in Phase I trials. Topotecan and iridotecan, two water-soluble derivatives, have undergone Phase I trials, showing mostly intestinal toxicity, followed by bone marrow depression.     

Postoperative change of anti-Thomsen-Friedenreich and Tn IgG level： The follow-up study of gastrointestinal cancer patients

AIM： To study the influence of tumor removal on the serum level of IgG antibodies to tumor-associated Thomsen-Friedenreich （TF）, Tn carbohydrate epitopes and xenogeneic αGal, and to elucidate on the change of the level during the follow-up as well as its association with the stage and morphology of the tumor and the values of blood parameters in gastrointestinal cancer. METHODS： Sixty patients with gastric cancer and 34 patients with colorectal cancer in stages Ⅰ-Ⅳ without distant metastases were subjected to follow- up. The level of antibodies in serum was determined by the enzyme-linked immunosorbent assay （ELISA） using synthetic polyacrylamide （PAA） glycoconjugates. Biochemical and haematological analyses were performed using automated equipment. RESULTS： In gastrointestinal cancer, the TF antibody level was found to have elevated significantly after the removal of G3 tumors as compared with the preoperative level （u = 278.5, P 〈 0.05）. After surgery, the TF and Tn antibody level was elevated in the majority of gastric cancer patients （sign test, 20 vs 8, P 〈 0.05, and 21 vs 8, P 〈 0.05, respectively）. In gastrointestinal cancer, the elevated postoperative level of TF, Tn and αGal antibodies was noted in most patients with G3 tumors （sign test, 22 vs 5, P 〈 0.01; 19 vs 6, P 〈 0.05; 24 vs 8, P 〈 0.01, respectively）, but the elevation was not significant in patients with G1 ＋ G2 resected tumors. The postoperative follow-up showed that the percentage of patients with G3 resected tumors of the digestive tract, who had a mean level of anti-TF IgG above the cut- off value （1.53）, was significantly higher than that of patients with G1 ＋ G2 resected tumors （χ2 = 3.89, all patients; χ2 = 5.34, patients without regional lymph node metastases; P 〈 0.05）. The percentage of patients with a tumor in stage I, whose mean anti-TF IgG level remained above the cut-off value （1.26）, was significantly higher than that of patients with the cancer in stages Ⅲ-Ⅳ     

血清CEA、CYFRA21-1与非小细胞肺癌化疗疗效及预后的临床研究

目的研究血清癌胚抗原（CEA）及细胞角蛋白19片断（CYFRA21-1）在评价非小细胞肺癌（NSCLC）患者化疗疗效及预后中的临床意义。方法 120例NSCLC患者接受2个周期含铂类方案的联合化疗,检测血清CEA及CYFRA21-1表达水平的变化,同时行影像学检查评价客观疗效,应用ROC曲线评价血清CEA及CYFRA21-1下降率在评估化疗疗效中的作用。结果 2个周期化疗后以影像学方法评价的客观有效率为36.4%,化疗后CEA下降率预测化疗疗效的最佳截断点为19.8%,化疗后CYFRA21-1下降率预测化疗疗效的最佳截断点为35.5%,血清CEA、CYFRA21-1下降率与影像学客观疗效有明显的相关性。结论血清CEA和CYFRA21-1下降率是反映NSCLC化疗疗效的可信指标。     

Early postoperative CEA level is a better prognostic indicator than is preoperative CEA level in predicting prognosis of patients with curable colorectal cancer

Purpose

Carcinoembryonic antigen (CEA) measurements performed preoperatively and during the early postoperative period were examined prospectively to assess their prognostic value for colorectal cancer (CRC) patients receiving curative surgery.

Methods

Between 2000 and 2004, 1,361 patients with CRC who underwent curative surgery at the Taipei Veterans General Hospital were enrolled prospectively. CEA was measured prior to surgery and during the third or fourth postoperative week. The endpoint was length of postoperative disease-free survival, and prognostic importance was determined using the log-rank test and Cox regression hazard model.

Results

Six hundred (44.1%) CRC patients had high CEA concentrations preoperatively, and 188 (13.8%) patients retained high values postoperatively. Within the median follow-up period of 61 (6?C108) months, CRC recurred in 313 patients. By univariate analysis TNM staging, tumor differentiation, lymphovascular invasion, preoperative CEA concentration, and postoperative CEA concentration affected the outcome. By multivariate analysis, the prognostic importance of postoperative CEA was retained (95% CI, 1.73?C3.01; HR?=?2.28) but that of preoperative CEA was lost (95% CI, 0.82?C1.33; HR?=?1.05). CRC recurred earlier in patients with high postoperative CEA concentrations; metastasis to the liver was common (72.3%) among patients in this group.

Conclusions

Early postoperative CEA concentration is an independent prognostic factor for CRC. Patients with high postoperative CEA values should receive aggressive follow-up examinations for early relapse of CRC, with special attention paid to recurrence at the liver.     

Postoperative survival of patients with potentially curable cancer of the colon

The association between histopathologic findings and postoperative survival in 442 patients with potentially curable carcinomas of the colon has been analyzed using Cox's regression model. The prognostic variables included in the study were age, sex, stage of disease according to Dukes' classification and Broders' grading, as well as presence/absence at the time of operation of venous and nerve invasion. The overall five-year postoperative survival rate was 46.6 percent. Using a model including all prognostic factors, sex and Dukes' classification were not found to be associated with survival. Broders' grading and/or nerve invasion yielded only a borderline statistical significance in the model that included all factors. The invasion of veins was almost always associated with invasion of nerves.     

Case of eosinophilic bronchitis and bronchiolitis associated with increased level of serum CEA in asthmatics]

A 50-year-old asthmatic woman showed peripheral blood eosinophilia, significantly increased level of CEA in serum (102.5ng/ml), and atelectasis of the right middle lobe on chest radiograph and CT. The level of CEA subsequently increased further, and then decreased with systemic corticosteroid therapy. Pathological findings of surgically biopsied lung showed eosinophilic broncho-bronchiolitis, without malignant cells. Two years later, chest CT demonstrated various findings such as mucoid impaction, peripheral bronchiectasis and centrilobular nodules, but allergic bronchopulmonary mycosis was not proved. These findings suggest that the eosinophilic bronchiolar inflammation in bronchial asthma caused an increase in serum CEA levels and various findings on chest CT.