肿瘤标记物结合病理对结直肠癌腹膜转移预判的研究

目的探讨血清CEA、CA19-9、CA125结合临床病理对术前判断是否具有结直肠癌腹膜转移的意义。 方法选取2014年1月至2017年10月在哈尔滨医科大学附属第二临床医学院行手术治疗的结肠癌及肿瘤位于直肠腹膜反折以上的直肠癌患者，共1 215例。其中，无腹膜转移的患者988例，同时性腹膜转移的患者227例，比较两组临床资料。 结果高分化腺癌、中分化腺癌、低分化腺癌、黏液腺癌、印戒细胞癌发生腹膜转移的几率分别为0、5.4%、35.6%、45.3%、75%，病理恶性程度越高越容易出现腹膜转移。血清CEA、CA19-9及CA125三者对结直肠癌腹膜转移的辅助诊断中，以CA125最为敏感，敏感度为100%，曲线下面积为0.897，CA125的这两项明显高于CEA及CA19-9，其特异度与CEA接近，较CA19-9低。CA19-9的特异度最高，为86%，但其灵敏度（47%）、曲线下面积（0.669）为三者中最低。CEA、CA19-9、CA125增高越明显，发生腹膜转移的几率就越大，当CEA＋CA125增高或CA125＋CA19-9增高或CEA＋CA125＋CA19-9增高时，发生腹膜转移的几率分别为65.7%、73.1%、77.3%。 结论通过CEA、CA19-9、CA125结合临床病理等检查的辅助，可以提高术前诊断结直肠癌腹膜转移的准确率，有助于术前判断患者的病情及预后。

Study of tumor markers combined with clinicopathological diagnosis for prejudgement of peritoneal metastasis of colorectal cancer

ObjectiveTo explore the significance of serum CEA、CA19-9 and CA125 levels combined with clinicopathological diagnosis for preoperative diagnosis of peritoneum metastasis of colorectal cancer. MethodsA total of 1 215 patients with colorectal cancer and rectal cancer located above the rectum and peritoneum were collected from the Colorectal Cancer Institute of the Harbin Medical University from January 2014 to October 2017, including 988 patients without peritoneal metastasis and 227 patients with synchronous peritoneal metastasis, and a retrospective analysis was carried out to compare the clinical data of two groups. ResultsThe incidence of peritoneal metastasis in highly differentiated adenocarcinoma, moderately differentiated adenocarcinoma, low differentiated adenocarcinoma, mucous adenocarcinoma, and signet ring cell cancer was 0, 5.4%.35.6%, 45.3%, 75%, the higher the degree of pathological malignancy, the more prone to peritoneum metastasis. CA125 is the most sensitive in the diagnosis of peritoneal metastasis of colorectal cancer in the three cases of serum CEA, CA19-9 and CA125, it is 100%, area under curve is 0.897, both of them were significantly higher than the other two (CEA, CA19-9). The specificity was close to CEA, lower than CA19-9, the specificity of CA19-9 was the highest (86%), but sensitivity (47%) and area under the curve (0.669) were the lowest. The greater the increase of CEA, CA19-9 and CA125, the greater the probability of peritoneal metastasis. When CEA+ CA125 increased or CA125+ CA19-9 increased or CEA+ CA125+ CA19-9 increased, the probability of peritoneal metastasis was 65.7%, 73.1% and 77.3%, respectively. ConclusionThe accuracy of preoperative diagnosis of peritoneal metastasis of colorectal cancer can be improved by CEA, CA19-9 and CA125 combined with clinical pathology examination. It is helpful to predict the prognosis and prognosis of patients with colorectal cancer.