血清胸苷激酶、癌胚抗原及糖类抗原199对结肠癌术后复发转移的预测价值

摘要

目的 探讨血清胸苷激酶1(TK1)、癌胚抗原(CEA)及糖类抗原199(CA199)对结肠癌术后复发转移的预测价值.方法 回顾性选取2011年3月至2015年12月保定市传染病医院和保定市第一医院收治的行手术治疗的结肠癌患者140例,根据患者在随访期间是否发生复发转移分为未复发转移组(n=94)和复发转移组(n=46).比较2组患者的临床资料、术前血清TK1、CEA及CA199水平.采用SPSS 19.0统计软件进行数据处理.应用受试者工作特征(ROC)曲线分析TK1、CEA及CA199预测结肠癌根治术后复发转移的价值. Pearson 相关分析复发转移患者血清TK1、CEA 及CA199 之间的相关性.结果 复发转移组TK1(76.1%vs 51.1%)、CEA(91.3%vs 64.9%)及CA199(84.8%vs 58.5%)阳性率显著高于未复发转移组(P＜0.05).复发转移组血清TK1[(3.70 ±1.62) vs (2.36 ±1.08)pmol/L]、CEA[(28.63 ±9.14) vs (17.42 ±5.38)ng/ml]及CA199[(75.26 ±17.30) vs (63.48 ±12.45)U/ml]水平均显著高于未复发转移组(P＜0.05). ROC曲线显示,血清TK1、CEA及CA199预测结肠癌患者复发转移的最佳截断点分别为2.96 pmol/L、22.63 ng/ml和69.24 U/ml,3项联合预测结肠癌患者复发转移的AUC(95%CI)[0.872(0.813～0.935)]明显优于TK1[0.730(0.672～0.791)]、CEA[0.804(0.744～0.865)]及CA199[0.762(0.703～0.823)],其敏感度和特异度分别为86.5%和82.4%. Pearson相关分析显示,复发转移患者血清TK1与CEA(r=0.760,P＜0.01)和CA199(r=0.702,P＜0.01)呈正相关,血清CEA与CA199呈正相关(r=0.813,P＜0.01).结论 复发转移患者术前血清TK1、CEA及CA199水平明显升高,3项联合检测对预测结肠癌术后复发转移的价值较高.%Objective To investigate the predictive values of serum thymidine kinase 1 (TK1), carcinoembryonic antigen (CEA) and carbohydrate antigen 199 ( CA199) in postoperative recurrence and metastasis of colon cancer.Methods Totally 140 cases of colon cancer treated surgically in our 2 hospitals from March 2011 to December 2015 were enrolled in this study.The patients were divided into non-recurrence or -metastasis group ( n =94 ) and recurrence and metastasis group ( n =46 ) according to whether recurrence or metastasis occurred during follow-up.Their clinical data, and preoperative serum levels of TK1, CEA and CA199 were compared between the 2 groups.SPSS statistics 19.0 was used for data processing.The values of TK1, CEA and CA199 to predict the recurrence and metastasis of colonic cancer were analyzed by using the receiver operating characteristic (ROC) curve.The correlation of serum TK1, CEA and CA199 in patients with recurrent and metastatic colon cancer was analyzed by Pearson correlation . Results The positivity rates of TK1 (76.1%vs 51.1%), CEA (91.3%vs 64.9%) and CA199 (84.8%vs 58.5%) were signifi-cantly higher in the recurrence and metastasis group than the non-recurrence or -metastasis group ( P＜0.05).Similar results were found in the serum levels of TK1 [(3.70 ±1.62) vs (2.36 ±1.08) pmol/L], CEA [(28.63 ±9.14) vs (17.42 ±5.38)ng/ml] and CA199 [(75.26 ±17.30) vs (63.48 ±12.45) U/ml](all P＜0.05).The ROC curve showed that the best cut-off values of serum TK1, CEA and CA199 for predicting the recurrence and metastasis of colon cancer were 2.96 pmol/L, 22.63 ng/ml and 69.24 U/ml,respectively.In the prediction for colon cancer, the area under ROC curve when the 3 molecules jointed together [95%CI, 0.872(0.813-0.935)]was significant larger than they used solely [TK1: 0.730(0.672-0.791), CEA: 0.804(0.744-0.865), CA199: 0.762(0.703-0.823)], with a sensitivity of 86.5%and a specificity of 82.4%.Pearson correlation analysis showed that serum TK1 level was positively correlated with those of CEA (r=0.760, P＜0.01) and CA199 (r=0.702, P＜0.01) in the patients with recurrent metastatic colon cancer , and that of CEA also had a positive correlation with that of CA 199 (r=0.813, P＜0.01). Conclusion The preoperative serum levels of TK1, CEA and CA199 are significantly higher in the patients doomed to recurrence and metastasis.And the joint test of the 3 molecules is of much higher value for predicting the recurrence and metastasis of colon cancer after operation.