血清CEA在结直肠癌术后复发的预测作用初探

目的研究术前血清癌胚抗原（CEA）水平与结直肠癌预后的关系及术后CEA水平升高与复发类型的关系。方法对464例结直肠癌根治术后患者进行回顾性分析,通过COX比例风险模型得出影响结直肠癌预后的独立预测因素。应用ROC曲线探讨CEA作为结直肠术后复发的预测指标的意义及最佳临界值的划分。结果多因素分析表明,术前血清CEA水平升高是结直肠癌术后复发独立的预测指标（P=0.01）;对于ⅢB期患者,术前CEA浓度为4.1μg/L,Youden指数最高,为判断预后的最佳临界值。术后CEA水平升高在局部复发仅占36.6%,单发转移占66.7%,多脏器转移阳性率则高达75.0%。结论术前血清CEA水平升高是影响结直肠癌预后的独立因素。作为影响预后的分层指标,血清CEA的临界值可能与目前临床常用的诊断标准有所不同。术后血清CEA检查有利于结直肠癌复发的早期发现,对于远处转移的提示作用更为明显。

Role of serum carcinoembryonic antigen level in predicting relapse of colorectal cancer after radical surgery

Objective To study the correlation of serum carcinoembryonic antigen （CEA） level with the prognosis and relapse of colorectal cancer （CRC） after operation. Methods A total of 464 consecutive patients with CRC after radical surgery included in this study were retrospectively analyzed. Cox multivariate regression model was used to observe independent predicting factors for the prognosis of CRC. Receiver operating characteristic curve （ROC） was used to evaluate the cutoff value of S-CEA level as a predicting factor for the prognosis of CRC. Results Multivariate analysis showed that elevated CEA level before operation was the independent predicting factor for the relapse of CRC（P=0.01）. The cutoff value of CEA level （4.1μ g/L） in Ⅲ B stage CRC patients before operation was found to be a predicting factor for the prognosis of CRC, with a sensitivity of 69% and a specificity of 80%. The CEA level was elevated in 36.6% patients with local recurrence, in 66.7% patients with single organ metastasis, and in 75.0% in patients with multi-organ metastasis, respectively, after operation. Conclusion Preoperative serum CEA level is a reliable predictive factor for the recurrence of CRC after radical operation. As a predicting factor for the relapse and prognosis of CRC, the cutoff value of serum CEA level may be used as a diagnostic index different from the current diagnostic criteria for CRC. CEA test provides a method for the early detection of relapse, especially distant metastasis of CRC.