局部晚期直肠癌新辅助治疗中CEA、CA199的变化及临床意义

摘要

Objective To study the expression and changes of tested values of CEA and CA199 in the pre-operative new adjuvant therapy for patients with local advanced rectal cancer,and to analyze their clinical significance in curative effects and prognosis analysis of the new adjuvant therapy. Methods 66 patients with local progressive middle and low-er rectal cancer who were admitted to Department of Radiotherapy in Shanxi Tumor Hospital from September 2013 to September 2014 were retrospectively analyzed.According to the TNM staging method co-initiated by UICC and AJCC:among 66 patients,19 patients were in stage II,37 patients were in stage Ⅲ and 10 patients were in stage Ⅳ.Prior to and after the new adjuvant therapy,the patients were all given the test of CEA and CA199 level,and were all given re-lated imaging tests such as CT or MRI.Postoperative pathological results were evaluated according to TRG grading cri-teria of pathological regression.66 patients were all given new adjuvant therapy (concurrent radiochemotherapy before the surgery) for 4-8 weeks before receiving surgery. Results Expression of CEA and CA199 levels was significantly dif-ferent in clinical staging (P<0.01);expression of CEA and CA199 was not correlated with local advanced rectal cancer (P>0.05);after the completion of new adjuvant therapy,CEA and CA199 levels significantly reduced compared to those before the therapy (P<0.01);serum CEA level before the new adjuvant therapy was an important factor influencing the treatment outcome (P<0.05). Conclusion CEA and CA199 are of great clinical significance in the judgement of curative effects and assessment of disease conditions for pa-tients with local advanced rectal cancer receiving pre-operative concurrent radiochemotherapy and new adjuvant therapy.%目的：研究CEA、CA199在局部晚期直肠癌患者术前新辅助治疗中检测值的表达与变化，分析其对新辅助治疗的效果及预后分析的临床意义。方法回顾性分析山西省肿瘤医院放疗科2013年9月~2014年9月收治的66例局部进展期中低位直肠癌患者，按照国际抗癌联盟和美国肿瘤联合会联合制订的TNM分期法，66例患者中Ⅱ期19例，Ⅲ期37例，Ⅳ期10例。患者在新辅助治疗前后均进行血清CEA、CA199水平检测，均行CT或MRI等相关影像检查，术后病理结果按照病理消退TRG分级标准进行评估。66例患者均行新辅助治疗(术前同步放化疗)后4~8周进行手术。结果 CEA、CA199水平的表达在临床分期中存在显著差异(P<0.01)；CEA、CA199水平的表达在局部晚期直肠癌中无相关性(P>0.05)；新辅助治疗结束后CEA、CA199水平较治疗前明显下降(P<0.01)，新辅助治疗前的血清CEA水平是影响治疗转归的重要因素(P<0.05)。结论 CEA、CA199对局部晚期直肠癌患者行术前同步放化疗新辅助治疗的疗效判断、病情评估有重要的临床意义。