术前血清CA19-9水平对胃癌患者生存预后的影响

  目的   探讨胃癌患者术前检测血清CA19-9的必要性及其对患者预后评估的意义。   方法   收集2003年1月至2008年10月间天津医科大学肿瘤医院收治的513例术前检测血清CA19-9的胃癌患者的临床病理资料，分析CA19-9水平与临床病理因素的关系及其与预后的关系。   结果   513例患者中CA19-9升高者86例（16.8%），CA19-9升高与高龄、大体分型（BorrmannⅢ、Ⅳ型）、组织学类型（低分化、未分化）及浸润深度相关。CA19-9正常（< 39 U/mL）和升高（≥39 U/mL）患者5年生存率分别为45.7%和25.6%，差异有统计学意义（P < 0.001）。分层分析显示，CA19-9水平仅与TNM Ⅲ期患者预后相关（P=0.001）。多因素预后分析证实，CA19-9升高是影响胃癌患者根治术后生存的独立危险因素（HR=1.47，P=0.008）。   结论   术前检测血清CA19-9可为胃癌患者预后评估提供信息，CA19-9升高可能是胃癌根治术后影响患者预后的独立危险因素。 

The effects of preoperative level of serum CA19-9 on the prognosis of gastric cancer patients after radical resection

  Objective   The influences of detection of the preoperative level of serum CA19-9 were analyzed on the prognosis of gastric cancer patients.   Methods   A total of 513 gastric patients with preoperative CA19-9 detection were enrolled and underwent radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital from January 2003 to October 2008. Clinico-pathological variables associated with the CA19-9 level were analyzed, and the prognostic value of CA19-9 was evaluated.   Results   Eighty-six (16.8%) patients manifested an increased CA19-9 level, which was associated with ageing, Borrmann types Ⅲand Ⅳ, undifferentiated type, and advanced T stage. The five-year survival rates were 45.7% and 25.6% for patients with normal (< 39 U/mL) and significantly high CA 19-9 levels (≥39 U/mL), respectively. Differences in survival rates between the patient groups were statistically significant (P < 0.001). Tumor-node-metastasis (TNM)-stratified analysis revealed a difference in overall survival for patients with stage Ⅲ tumors. The significantly increased CA19-9 level was an independent prognostic factor for gastric cancer patients after radical surgery based on multivariate analysis.   Conclusions   Detection of preoperative level of serum CA19-9 could provide important information for prognostic evaluation of gastric cancer patients. CA19-9 was a potential independent prognostic factor for gastric cancer patients after surgery.