摘要
目的探讨Ⅲ期胃癌(GC)患者行GC根治术后复发转移的特征及预后影响因素。方法选取行GC根治术的Ⅲ期GC患者181例为研究对象,收集患者临床资料[性别、年龄、Tumor-Node-Metastasis(TNM)分期、N分期,肿瘤部位];分别于术前1周及术后转移时采集所有患者空腹静脉血,采用迈瑞6800血球分析仪检测患者常规血液指标及血小板(PLT),用罗氏Cobas c702全自动生化分析仪和罗氏Cobas e602电化学发光免疫分析仪检测患者血清总蛋白(TP)、白蛋白(ALB)和甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原199(CA199)、糖类抗原153(CA153)、糖类抗原242(CA242);术后随访2~80个月,记录患者发生复发转移部位和时间;根据术后是否发生复发转移,将患者分为复发转移组(n=30)与无复发转移组(n=151),比较2组患者术前上述血液生化指标,比较复发转移组Ⅲ期GC患者转移前、后血清CEA、CA125、CA199水平;运用Cox单因素及多因素分析影响Ⅲ期GC患者预后的危险因素,采用Kaplan-Meier(K-M)法分析Ⅲ期GC患者术后1、2及3年的总体生存率。结果约90%的复发转移Ⅲ期GC患者于术后0~24个月内出现复发转移者,这些患者术前血清TP、ALB低于无复发转移组(P<0.05),且发生复发转移后血清CEA、CA125、CA199水平较转移前升高(P<0.05);术前血清CA125含量≥35 kU/L(HR=3.508,95%CI为1.548~7.950)、术后复发转移(HR=2.613,95%CI为1.576~4.333)是Ⅲ期GC术后患者预后的独立危险因素(P<0.05),且复发转移组Ⅲ期GC患者的中位生存时间低于无复发转移组(P<0.001)。结论术前低水平血清TP、ALB是Ⅲ期GC患者术后出现复发转移的危险因素;术前高水平血清CA125(CA125含量≥35 kU/L)、术后复发转移是Ⅲ期GC术后患者预后的不良因素。
Objective To investigate the characteristics and prognostic factors of recurrence and metastasis in patients with stage Ⅲ gastric cancer(GC)after radical GC surgery.Methods A total of 181 patients with stage Ⅲ GC who underwent radical GC surgery were selected as the subjects.The clinical data of the patients were collected,including gender,age,Tumor-Node-Metastasis(TNM)stage,N stage,tumor location.At one week before surgery and at postoperative metastasis,fasting venous blood was collected from all patients.Mindray 6800 blood cell analyzer was used to measure the patients’routine blood indicators and platelets(PLT).Roche Cobas c702 automatic biochemical analyzer and Roche Cobas e602 electrochemiluminescence immunoassay analyzer were applied to detect the patients’serum total protein(TP),albumin(ALB)and alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA),carbohydrate antigens(CA125,CA199,CA153,and CA242).The follow-up visits lasted for 2 to 80 months after surgery.The location and time of recurrence and metastasis of patients were recorded.According to whether the recurrence and the metastasis occur after surgery,the patients were divided into recurrence&metastasis group(n=30)and non-recurrence&metastasis Group(n=151).The above-mentioned blood biochemical indicators before surgery were compared between two groups.The levels of serum CEA,CA125,CA199 in recurrence&metastasis group were compared between before and after the recurrence and metastasis.Cox univariate and multivariate analysis were used to analyze the risk factors of the prognosis of these patients.Kaplan-Meier(K-M)method was used to analyze the overall survival rate of patients with stage III GC at 1,2,and 3 years after surgery.Results Among patients with recurrence and metastasis,there were 90%patients whose recurrence and metastasis occurred within 0-24 months after surgery.The preoperative serum TP and ALB of these patients were lower than those in the non-recurrence and metastasis group(P<0.05),and the levels of their serum CEA,CA125,and CA199 after recurrence and metastasis were higher than those before metastasis(P<0.05).Preoperative serum CA125≥35 kU/L(HR=3.508,95%CI was 1.548 to 7.950),postoperative recurrence and metastasis(HR=2.613,95%CI was 1.576 to 4.333)were independent risk factors for the prognosis of patients with stage Ⅲ GC after surgery(P<0.05).The median survival time of the recurrence&metastasis group was lower than that of non-recurrence&metastasis group(P<0.001).Conclusion Low preoperative serum TP and ALB are risk factors for postoperative recurrence and metastasis in patients with stageⅢGC.High preoperative serum CA125(≥35 kU/L)and postoperative recurrence and metastasis predict poor prognosis of patients with stageⅢGC.
作者
李红羽
夏英
韦四喜
杜洪
袁婷
金泳
黄海
LI Hongyu;XIA Ying;WEI Sixi;DU Hong;YUAN Ting;JIN Yong;HUANG Hai(School of Clinical Laboratory Science,Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Clinical Laboratory,the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550001,Guizhou,China;Center for Clinical Laboratory,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)
出处
《贵州医科大学学报》
CAS
2021年第12期1438-1444,1457,共8页
Journal of Guizhou Medical University
基金
贵州省重大疾病临床检测分子标志物研究科技创新人才团队[黔科合平台人才(2019)5610]。
关键词
白蛋白类
Ⅲ期胃癌根治术后
复发转移
预后因素
总蛋白
糖类抗原125
albumins
after radical surgery of stageⅢgastric cancer
recurrence and metastasis
prognostic factors
total protein
carbohydrate antigen 125(CA125)
