CA199 在判断CEA 正常的中晚期结直肠癌患者预后中的价值*

目的：探讨术前血清中CEA 、CA199 水平与中晚期结直肠癌患者预后的关系，CA199 用于判断CEA 正常的中晚期结直肠癌患者预后的可行性。方法：筛选2004年1 月至2006年8 月间在北京大学肿瘤医院行结直肠癌手术治疗的中晚期患者314例，术前均利用化学发光免疫方法检测血清CEA 及CA199 水平，分析其表达与结直肠癌患者各临床病理因素以及生存预后的关系。结果：314 例结直肠癌患者中术前 CEA 正常、CA199 升高的患者仅占 5.4%，28.3%的患者二者同时升高，21.3%的患者仅 CEA 升高。Kaplan-Meier 生存曲线分析表明，相比CEA 正常的患者，术前CEA 升高患者的无病生存期（P < 0.001）和总生存期（P < 0.001）均明显缩短；与CA199 正常的患者相比，术前CA199 升高患者的无病生存期（P < 0.001）和总生存期（P < 0.001）也均明显缩短；进一步分层分析表明术前CEA 正常而CA199 升高患者的5 年生存期明显低于CEA 升高而CA199 正常的患者（P = 0.012）。 多因素分析显示血清CA199 水平升高是提示结直肠癌术后预后不良的独立危险因素（HR= 2.025，95％CI ：1.331～3.082，P = 0.001）。 结论：血清CEA 和CA199 联合检测有助于判断中晚期结直肠癌患者的预后。CA199 水平可用于辅助判断术前血清CEA 未升高患者的预后。术前CA199 升高的患者比CEA 升高患者的5 年生存期更短。

Prognostic value of preoperative CA199 in advanced colorectal cancer patients with normal carcinoembryonic antigen level

Objective:To investigate whether increased levels of preoperative carcinoembryonic antigen (CEA) and CA199 were associated with the mortality of patients with advanced colorectal cancer and to determine whether CA 199 can be used to discriminate patients with normal preoperative CEA level from good to poor prognosis.Methods:A total of 314 patients with advanced colorectal cancer cases who underwent primary tumor resection were collected from 2014 to 2016 at Peking University Cancer Hospital and Institute. Preoperative CEA and CA199 serum levels were examined using electrochemiluminescence immunoassay. The association of CEA and CA199 with clinicopathologic features and their possible prognostic values were analyzed. Results:In the tested patients, 5.4% of whom had increased CA199 level but not up-regulated CEA level, whereas 28 .3% only had increased CEA level, and 21 .3% had both CEA and CA199 levels increased. Kaplan-Meier survival curves indicated that patients with elevated preoperative CEA level had worse disease-free survival (DFS) and overall survival (OS) than those with normal CEA ( P<0.001 and P<0.001, respectively). Meanwhile, patients with elevated CA 199 level had worse DFS and OS than those with normal CA 199 (P<0.001 and P<0.001, respectively). Preoperative CA 199 level could be used in discriminating patients with normal CEA from good to poor prognosis (P=0.012). Multivariate analysis revealed that elevated CA 199 level was an independent prognostic factor for OS in patients with advanced colorectal cancer (HR= 2.025, 95%CI=1.331- 3.082, P=0.001). Conclusion: Combined detection of preoperative CEA and CA199 can be used in evaluating the prognosis of patients with advanced colorectal cancer. Preoperative serum CA 199 level can be used in evaluating the prognosis of patients with colorectal cancer without an increase in CEA level. Patients with increased CA199 level had worse 5-year survival than those with increased CEA level.