术前血清肿瘤标志物水平在直肠癌术前分期中的应用评价

目的]探讨直肠癌术前血清肿瘤标志物水平与肿瘤浸润深度及淋巴结转移之间的关系,评价其在直肠癌术前分期中的应用价值。方法]回顾性分析北京大学肿瘤医院178例行手术治疗直肠癌患者的术前血清肿瘤标志物（CEA、CA199、CA724、CA242）水平和临床病理资料。结果]单因素分析结果表明直肠癌肿瘤浸润深度与术前CEA、CA242水平、肿瘤部位、最大径、大体类型、分化程度、淋巴结转移相关（P〈0.05）。淋巴结转移与肿瘤大体类型、分化程度、最大径、脉管癌栓、浸润深度相关（P〈0.05）。多因素分析表明直肠癌患者术前的CEA水平和肿瘤最大径是肿瘤浸润深度的独立危险因素;肿瘤浸润深度和脉管癌栓是淋巴结转移的独立危险因素。结论]术前血清CEA水平是影响直肠癌术前T分期的重要因素,术前血清肿瘤标志物水平对直肠癌术前分期的应用价值有限。

Evaluation of Preoperative Serum Levels of Tumor Markers in Preoperative Staging of Rectal Cancer

Purpose] To investigate the relationship between preoperative serum tumor marker levels with the depth of tumor invasion aml lymph node metastasis,and to evaluate the application in the preoperative staging in the patients with rectal carcinoma.Methods ] The level of preoperative serum tumor markers（CEA ,CA199 ,CA724 ,CA242） and elinicopathologic features in 178 patients with surgery in Beijing Cancer Hospital were retrospectively evaluated. Resultsl The depth of tumor invasion in patients with rectal cancer was significantly related to preoperative CEA,CA242 levels,tumor location ,tumor size, macroscopic type,differentiation and lymph node metastasis（P〈0.05）. Lymph node metastasis was significantly correlated with macroscopic type,differentiation,tumor size,lym- phovascular invasion and depth of tumor invasion （P〈0.05）. Multivariate regression analysis showed that preoperative CEA level and tumor size were independent factors of depth of tumor invasion in patients with rectal cancer. The depth of invasion and lymphovascular involvement vasion were independent factors in patients with rectal cancer. Conclusion] Preoperative CEA level seems to be promising to predict the depth of tumor invasion in the patients with rectal cancer. The value of preoperative serum tumor marker level in predicting the stage of rectal carcinoma before surgery is limited.