摘要
目的探讨结直肠癌患者腹腔灌洗液中肿瘤标记物对肿瘤腹膜转移的诊断价值.方法本研究纳入2017年9月至2019年6月于北京大学人民医院胃肠外科行手术治疗的结直肠癌患者227例为研究对象.取开腹后即刻腹腔灌洗液300 ml进行传统细胞学(PLC)检测,其中134例患者进行了腹腔灌洗液肿瘤标记物(pTM)检测.对所有患者的临床病理资料进行单因素分析明确腹膜转移的危险因素;绘制pTM ROC曲线确定最佳cutoff值;采用配对资料x^2检验比较PLC和pTM检测结果的差异.结果本组结直肠癌患者腹腔灌洗液脱落细胞学阳性率为12.3%(28/227).单因素分析结果提示:年龄>65岁,肿瘤T分期为T3+、淋巴结转移、分化类型为黏液腺癌以及血清CA125、血清CA19-9升高均与肿瘤腹膜转移有关(均P<0.05).结直肠癌患者腹膜转移pTM最佳cutoff值:pCEA 17.095 ng/dl,灵敏度58.3%,特异度93.9%;pCA19-94.515 U/ml,灵敏度83.3%,特异度80.0%;pCA125303.2U/ml,灵敏度58.3%,特异度95.7%;pCA-7243.01U/ml,灵敏度66.7%,特异度95.7%.结直肠癌患者腹膜微转移pTM最佳cutoff值:pCA19-93.43 U/ml,灵敏度100%,特异度72.2%.pCA19-9阳性率为29.85%,高于PLC,差异有统计学意义(x^2=2.00,P<0.05).结论结直肠癌腹膜转移与患者的年龄、肿瘤T分期、淋巴结转移、肿瘤病理类型以及血清CA125、CA19-9升高均有关;pTM对结直肠癌腹膜转移具有诊断价值,其中pCA19-9诊断价值最高.
Objective To determine the diagnostic value of tumor markers in peritoneal lavage fluid from colorectal cancer patients for tumor peritoneal metastasis.Methods A total of 227 colorectal cancer patients who undergoing surgical treatment were included.300 ml of peritoneal lavage fluid was irrigated immediately upon laparotomy for traditional cytology(PLC)testing,134 patients were tested for tumor marker of peritoneal lavage fluid(pTM).Univariate analysis was performed to determine the risk factors for peritoneal metastasis;pTM ROC curve was used to determine the best cutoff value;paired chi-square test was used to compare the difference between PLC and pTM detection.Results The positive rate of PLC was 12.3%(28/227).Age>65,stage T3+,lymph node metastasis,mucinous adenocarcinoma and increased serum CA125,CA19-9 are related to peritoneal metastasis;The best cutoff value of pTM for peritoneal metastasis:pCEA 17.095 n g/d l,sensitivity 58.3%,specificity 93.9%;pCA19-94.515 U/m l,sensitivity 83.3%,specificity 80.0%;pCA125303.2 U/m l,sensitivity 58.3%,specificity 95.7%;pCA-7243.01 U/m l,sensitivity 66.7%,specificity 95.7%;The best cutoff value of pTM for peritoneal micrometastasis:pCA19-93.43 U/m l,sensitivity 100%,specificity 72.2%.The positive rate of pCA19-9 was 29.85%,which was higher than that of PLC(X^2=2.00,P<0.05).Conclusion Peritoneal metastasis of colorectal cancer is related to tumor T stage,lymph node metastasis,tumor pathological type,and increased serum CA125 and CA19-9;pTM has diagnostic value for peritoneal metastasis of colorectal cancer.
作者
刘欣
周宇石
谢启伟
尹慕军
杨晓东
姜可伟
郑智元
梁斌
叶颖江
王杉
Liu Xin;Zhou Yushi;Xie Qiwei;Yin Mujun;Yang Xiaodong;Jiang Kewei;Zheng Zhiyuan;Liang Bin;Ye Yingjiang;Wang Shan(Department of Gastroenterological Surgery,Peking University People's Hospital,Beijing 100044,China;Department of Surgical Oncology,Peking University People's Hospital,Beijing 100044,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2020年第8期593-597,共5页
Chinese Journal of General Surgery
关键词
结直肠肿瘤
腹膜
肿瘤转移
腹腔冲洗
肿瘤标记
生物学
Colorectal neoplasms
Peritoneum
Neoplasm metastasis
Peritoneal lavage
Tumor markers,biological
