晚期结直肠癌患者化疗后血清CEA、CA199水平一过性升高的临床意义

背景与目的：晚期结直肠癌患者化疗后血清CEA和（或）CA19—9水平增高，常提示肿瘤进展。然而国外有文献报道部分化疗有效的晚期结直肠癌患者可出现血清CEA水平一过性增高。本研究主要通过分析晚期结直肠癌患者姑息性化疗前后血清CEA和CA19—9水平的动态变化，探讨我国晚期结直肠癌患者血清CEA水平和（或）CA19—9水平一过性增高的发生率及与临床预后的关系。方法：收集中山大学肿瘤防治中心收治的121例晚期结直肠癌患者的临床资料，所有患者经病理学证实，PS评分（ECOG）≤2分，接受含奥沙利铂和（或）伊立替康方案化疗，化疗前后进行血清CEA和CA19-9水平的动态测定。结果：121例患者中有14例发生了CEA“一过性增高”，发生率为11．6％（14／121）。CEA“一过性增高”患者基线CEA的中位水平为45ng／mL（9．67～2208μg／L），中位峰值水平为80．1μg／L（13．38～4044μg／L）。从化疗开始至出现CEA“一过性增高”的中位时间为4周（2-6周），中位持续时间为6．5周（4～14周）。14例患者中有11例接受含奥沙利铂方案的化疗：3例患者接受含伊立替康方案的化疗。14例患者中近期疗效评价部分缓解7例，病情稳定7例。5例（3．8％）患者化疗后发生了血清CA19—9水平“一过性增高”，但与临床疔效无关。结论：我国晚期结直肠癌患者接受含奥沙利铂方案或含伊立替康方案化疗时存在着CEA“一过性增高”现象，“一过性增高”并非提示肿瘤进展．而与较好的化疗疗效有关。化疗后血清CA19—9水平“一过性增高”与近期疗效无关。

Clinical significance of a transient increase in carcinoembryonic antigen and carbohydrate antigen 19-9 in patients with metastatic colorectal cancer receiving chemotherapy

Background and Objective, An increase in carcinoembryonic antigen （CEA） and/or carbohydrate antigen 19-9 （CA19-9） levels is generally considered as tumor progression in patients with metastatic colorectal cancer （MCRC）. However, a transient CEA surge has been observed in patients with MCRC responding to chemotherapy. This study was to investigate the clinical significance of transient CEA/CA19-9 surges in Chinese MCRC patients. Methods： One hundred and twenty-one MCRC patients with histologically proven adenocarcinoma and baseline ECOG performance status of ≤2 were treated with oxaplatin and （or） irinotecan-based chemotherapy regimens. Serum CEA and CA 19-9 levels were measured before and after chemotherapy. Results： Of the 121 patients, 14 （11.6%） had transient CEA surges with median baseline CEA level of 45 wg/L （9.67-2208 μg/L） and median surge peak level of 80.1 μg/L （13.38-4044 μg/L）. The transient CEA surge occurred at a median of 4 weeks （2-6 weeks）, and lasted for a medium of 6.5 weeks （4-14 weeks）. Of the 14 patients, 11 received oxaplatinbased chemotherapy; three received irinotecan-based chemotherapy. All the 14 patients showed clinical benefit from chemotherapy, among which seven achieved partial response and seven had stable disease. In the meantime, five patients （3.8%） had transient CA19-9 surges. However, no significant correlation was found between an increase in the CA19-9 level and clinical benefits. Conclusions, Transient CEA surges can be observed in Chinese MCRC patients receiving oxaplatin or irinotecan-based chemotherapy, which does not indicate tumor progression, but good therapeutic efficacy. A transient elevation of CA19-9 is not correlated to short-term clinical benefits.