摘要
背景结直肠癌(colorectal cancer,CRC)是国内外发病率和死亡率均靠前的恶性肿瘤,是世界性的重大公共卫生问题,它排在新诊断癌症的第三位,也是第四位癌症致死原因.积极探索一种结直肠癌术后肝转移的有效预测指标是目前研究重点与难点,若能通过某种方法早期检测出肝脏内肿瘤细胞的微转移,并采取有效的干预和综合治疗,这将会极大的改善结直肠癌患者预后.目的探讨CRC患者门静脉血血栓素A2(thromboxane A2,TXA2)、血管内皮生长因子(vascular endothelial growth factor,VEGF)、癌胚抗原(carcino embryonic antigen,CEA)水平变化对手术预后的预测价值.方法选取2017-05/2019-11我院112例CRC手术患者,根据术后6 mo有无肝转移分为观察组(肝转移,n=21)与对照组(无肝转移,n=91).比较两组临床资料、门静脉血TXA2、VEGF、CEA水平,分析CRC患者术后肝转移影响因素,评估门静脉血各指标水平与临床病理参数的相关性、对CRC患者术后肝转移的预测价值及与预后的关联性.结果门静脉血TXA2、VEGF、CEA水平:观察组>对照组(P<0.05);年龄、病灶大小、组织学分级、T分期、区域淋巴结转移、脉管瘤栓、手术方式、辅助化疗、门静脉血TXA2、VEGF、CEA水平均为CRC患者术后肝转移影响因素(P<0.05);CRC术后肝转移患者门静脉血TXA2、VEGF、CEA水平与年龄、病灶大小、T分期、区域淋巴结转移及脉管瘤栓呈正相关关系,与组织学分级呈负相关关系(P<0.05);门静脉血TXA2、VEGF、CEA水平联合预测CRC患者术后肝转移AUC最大,为0.929;结直肠癌患者门静脉血TXA2、VEGF、CEA高水平患者与低水平患者术后生存率相比,差异无统计学意义(P>0.05).结论门静脉血TXA2、VEGF、CEA水平高表达可能参与CRC术后肝转移过程,上述指标联合检测可为临床预测CRC术后肝转移与预后提供数据支持.
BACKGROUND Colorectal cancer(CRC)is a malignant tumor with high morbidity and mortality worldwide,representing a major public health problem.It ranks the third among newly diagnosed cancers and is the fourth cause of cancer death.There is currently an urgent need to find effective indexes for predicting liver metastasis after CRC surgery.Early detection of CRC liver micrometastasis is helpful for effective intervention and comprehensive treatment,which will greatly improve the prognosis of patients.AIM To explore the prognostic value of changes in portal vein thromboxane A2(TXA2),vascular endothelial growth factor(VEGF),and carcinoembryonic antigen(CEA)levels in patients with CRC after surgery.METHODS From May 2017 to November 2019,112 CRC patients at our hospital were selected and divided into either an observation group(liver metastasis,n=21)or a control group(no liver metastasis,n=91)according to whether there were liver metastases 6 mo after surgery.The clinical data and the levels of TXA2,VEGF,and CEA in portal vein blood were compared between the two groups,and the influencing factors of liver metastasis in patients with CRC were analyzed.The correlation between the levels of portal venous blood indicators and clinicopathological parameters,their predictive value for postoperative liver metastasis in patients with CRC,and their correlation with the prognosis were evaluated.RESULTS The levels of TXA2,VEGF,and CEA in portal vein blood were significantly higher in the observation group than in the control group(P<0.05).Age,lesion size,histological grade,T stage,regional lymph node metastasis,vascular tumor thrombosis,surgical methods,adjuvant chemotherapy,and portal vein blood TXA2,VEGF,and CEA levels were all influential factors for postoperative liver metastasis in CRC patients(P<0.05).Portal vein blood TXA2,VEGF,and CEA levels in patients with liver metastases after CRC were positively correlated with age,lesion size,T stage,regional lymph node metastasis,and tumor thrombus,and negatively correlated with histological grade(P<0.05).The AUC of combined detection of TXA2,VEGF,and CEA in the prediction of postoperative liver metastasis in CRC patients was the largest(0.929).There was no statistically significant difference in the postoperative survival rate of patients with high levels of TXA2,VEGF,and CEA in portal vein blood and those with low levels(P>0.05).CONCLUSION The high expression of TXA2,VEGF,and CEA in portal vein blood may be involved in the process of liver metastasis after CRC.The combined detection of the above indicators can provide data support for clinical prediction of liver metastasis and prognosis in patients with CRC after surgery.
作者
任慧
顾立强
陈晶晶
Hui Ren;Li-Qiang Gu;Jing-Jing Chen(Department of Surgery,Tianjin Ninghe District Hospital,Tianjin 300000;Anorectal Treatment Center,Tianjin People’s Hospital,Tianjin 300121,China)
出处
《世界华人消化杂志》
CAS
2021年第17期1006-1013,共8页
World Chinese Journal of Digestology
关键词
结直肠癌
门静脉血
血栓素A2
血管内皮生长因子
癌胚抗原
临床病理参数
预后
Colorectal cancer
Portal vein blood
Thromboxane A2
Vascular endothelial growth factor
Carcinoembryonic antigen
Clinicopathological parameters
Prognosis
