摘要
目的：探讨术前肿瘤标志物检测对肝内胆管细胞癌（ICC）淋巴结转移的预测价值。
方法：采用回顾性队列研究方法。收集2006年5月至2016年5月上海交通大学医学院附属新华医院收治的 69例ICC患者的临床病理资料。69例ICC患者中，24例术后病理学检查证实有淋巴结转移，设为有淋巴结转移组； 45例术后病理学检查证实无淋巴结转移，设为无淋巴结转移组。术前检测两组患者肿瘤标志物：AFP、CEA、前列腺特异抗原（PSA）、CA199、CA125、CA242、CA153、CA724、CA211、神经烯醇化酶（NSE）、鳞状上皮癌细胞抗原（SCC）。选取差异有统计学意义的指标构建受试者工作特征（ROC）曲线。根据ROC曲线计算各指标的临界值、灵敏度和特异度。计算差异有统计学意义的指标与术后病理学检查结果的符合率。观察指标：（1）血清肿瘤标志物总阳性率。（2）两组患者血清肿瘤标志物水平比较。（3）血清肿瘤标志物检测预测ICC淋巴结转移的ROC曲线分析及与术后病理学检查结果符合率。符合正态分布的计量资料采用±s表示，组间比较采用t检验。偏态分布的计量资料采用M（Q25，Q75）表示，组间比较采用Wilcoxon秩和检验。计数资料比较采用x2检验。有统计学意义的指标进一步行ROC曲线分析。
结果：（1）血清肿瘤标志物总阳性率：69例ICC患者AFP、CEA、PSA、CA199、CA125、CA242、CA153、CA724、CA211、NSE、SCC 11项肿瘤标志物的阳性率分别为27.5%（19/69）、29.0%（20/69）、4.3%（3/69）、69.6%（48/69）、36.2%（25/69）、50.7%（35/69）、26.1%（18/69）、21.7%（15/69）、62.3%（43/69）、31.9%（22/69）、21.7%（15/69）。其中，AFP、CEA、CA199、CA125、CA242、CA153、CA724、CA211、NSE、SCC阳性率均〉20%，列入两组患者比较指标。（2）两组患者血清肿瘤标志物水平比较：有淋巴结转移组ICC患者血清CA199、CA125、CA242、CA211分别为284.9 U/mL（42.5 U/mL，730.3 U/mL）、63.6 U/mL（23.4 U/mL，172.1 U/mL）、71.7 U/mL（25.6 U/mL，138.9 U/mL）、6.7 μg/L（3.9 μg/L，17.5 μg/L）；无淋巴结转移组分别为58.0 U/mL（25.9 U/mL，405.9 U/mL）、18.2 U/mL（11.7 U/mL，33.8 U/mL）、11.0 U/mL（3.7 U/mL，41.7 U/mL）、3.7 μg/L（2.7 μg/L，6.9 μg/L），两组比较，差异均有统计学意义（Z=2.016，3.213，3.143，2.482，P〈0.05）。（3）血清肿瘤标志物检测预测ICC淋巴结转移的ROC曲线分析及与术后病理学检查结果符合率：血清CA199、CA125、CA242、CA211 对应ROC曲线下面积分别为0.648（95%可信区间：0.515-0.781，P〈0.05），0.736（95%可信区间：0.608-0.864，P〈0.05），0.731（95%可信区间：0.603-0.859，P〈0.05），0.714（95%可信区间：0.581-0.847，P〈0.05）。血清CA199、CA125、CA242、CA211的阳性临界值分别为150.6 U/mL、35.7 U/mL、43.4 U/mL、6.0 μg/L，灵敏度分别为62.5%、66.7%、70.8%、62.5%，特异度分别为71.1%、82.2%、77.8%、75.6%。血清CA199、CA125、CA242、CA211与术后病理学检查结果符合率分别为68.1%（47/69）、76.8%（53/69）、75.4%（52/69）、71.0%（49/69）。
结论：血清CA199、CA125、CA242、CA211预测ICC患者淋巴结转移有重要临床价值。
Objective：To investigate the predictive value of preoperative serum tumor markers test for lymph node metastasis of intrahepatic cholangiocarcinoma （ICC）.
Methods：The retrospecgtive cohort study was conducted. The clinicopathological data of 69 patients with ICC who were admitted to the Xinhua Hospital of Shanghai Jiaotong University between May 2006 and May 2016 were collected. Among 69 patients with pathological diagnosis, 24 with lymph node metastasis were allocated into the lymph node metastasis group and 45 without lymph node metastasis were allocated into the nonlymph node metastasis group. Tumor markers of the 2 groups were preoperatively detected, including alphafetoprotein （AFP）, carcinoembryonic antigen （CEA）, prostate specific antigen （PSA）, CA199, CA125, CA242, CA153, CA724, CA211, neuronspecific enolase （NSE） and squamous cell carcinoma antigen （SCC）. Receiver operating characteristic （ROC） curve was built, and critical value, sensitivity and specificity were calculated based on ROC curve. Coincident rate between significant indicators and results of pathological examination was calculated. Observation indicators： （1） overall positive rates of tumor markers; （2） comparison of tumor markers levels in the 2 groups; （3） tumor markers predicted ROC curve of lymph node metastasis and coincident rate between ROC curve and results of postoperative pathological examination. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M（Q25, Q75） and comparison between groups was analyzed using the Wilcoxon rank sum test. Comparison of count data was analyzed by the chisquare test and Fisher exact probability. The statistically significant indicators were analyzed by the ROC curve.
Results：（1） Overall positive rates of tumor markers： positive rates of AFP, CEA, PSA, CA199, CA125, CA242, CA153, CA724, CA211, NSE and SCC in 69 patients were 27.5%（19/69）, 29.0%（20/69）, 4.3% （3/69）, 69.6%（48/69）, 36.2%（25/69）, 50.7%（35/69）, 26.1%（18/69）, 21.7%（15/69）, 62.3%（43/69）, 31.9%（22/69） and 21.7%（15/69）, respectively. Positive rates of AFP, CEA, CA199, CA125, CA242, CA153, CA724, CA211, NSE and SCC were more than 20%, which became comparison indicators of 2 groups. （2） Comparison of tumor markers levels in the 2 groups： levels of CA199, CA125, CA242 and CA211 were 284.9 U/mL （42.5 U/mL, 730.3 U/mL）, 63.6 U/mL （23.4 U/mL, 172.1 U/mL）, 71.7 U/mL （25.6 U/mL, 138.9 U/mL）, 6.7 μg/L （3.9 μg/L, 17.5 μg/L） in the lymph node metastasis group and 58.0 U/mL （25.9 U/mL, 405.9 U/mL）, 18.2 U/mL （11.7 U/mL, 33.8 U/mL）, 11.0 U/mL （3.7 U/mL, 41.7 U/mL）, 3.7 μg/L （2.7 μg/L, 6.9 μg/L） in the nonlymph node metastasis group, respectively, with statistically significant differences between the 2 groups （Z=2.016, 3.213, 3.143, 2.482, P〈0.05）. （3） Tumor markers predicted ROC curve of lymph node metastasis and coincident rate between ROC curve and results of postoperative pathological examination： area under the ROC curve of CA199, CA125, CA242 and CA211 were respectively 0.648 [95% confidence interval （CI）： 0.515-0.781, P〈0.05], 0.736 （95% CI： 0.608-0.864, P〈0.05）, 0.731 （95% CI： 0.603-0.859, P〈0.05）, 0.714 （95% CI： 0.581-0.847, P〈0.05）. The positive critical value, sensitivity and specificity of CA199, CA125, CA242 and CA21 were 150.6 U/mL, 35.7 U/mL, 43.4 U/mL, 6.0 μg/L and 62.5%, 66.7%, 70.8%, 62.5% and 71.1%, 82.2%, 77.8%, 75.6%, respectively. The coincident rate between ROC curve and results of postoperative pathological examination of CA199, CA125, CA242 and CA211 were 68.1%（47/69）, 76.8%（53/69）, 75.4%（52/69）, 71.0%（49/69）, respectively.
Conclusion：The levels of serum CA199, CA125, CA242 and CA211 can effectively predict lymph node metastasis of patients with ICC.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2017年第5期503-507,共5页
Chinese Journal of Digestive Surgery
关键词
胆管肿瘤
淋巴结转移
肿瘤标志物
Biliary neoplasms
Lymph node metastasis
Tumor markers
