摘要
目的:探讨术前癌胚抗原(carcinoembryonic antigen,CEA)水平升高对Ⅰ~Ⅲ期结肠癌患者预后的影响。方法:采用回顾性队列研究的方法收集SEER数据库中2010—2015年行根治性手术治疗的Ⅰ~Ⅲ期结肠癌患者的临床资料,根据术前CEA水平将患者分为正常组(≤5.0 ng/mL)与升高组(>5.0 ng/mL)。采用Kaplan-Meier法估计两组患者癌症特异性生存期,采用Log-rank检验对生存差异进行评估,采用Cox回归模型分别进行单因素及多因素分析评估术前CEA水平的预后作用,建立AJCC分期联合术前CEA水平的列线图预测模型并分析模型的区分度。结果:最终纳入患者17921例,术前CEA水平正常组11467例(64.0%),CEA水平升高组6454例(36.0%),中位随访时间为45(29,66)个月,末次随访中因结肠癌死亡患者2910例(16.24%),患者总体5年癌症特异性生存率为81.48%(95%CI:80.82%~82.14%)。术前CEA水平升高患者的AJCC分期更晚,分化程度更低,更易发生周围神经浸润。术前CEA水平升高组及正常组患者的5年癌症特异性生存率分别为72.75%及86.25%,差异有统计学意义(P<0.001)。多因素Cox回归分析显示术前CEA水平升高与结肠癌患者术后更短的癌症特异性生存期独立相关(HR=1.74,95%CI:1.62~1.88,P<0.001)。AJCC分期联合术前CEA水平的列线图预测模型的ROC曲线下面积大于单纯AJCC分期模型的ROC曲线下面积(0.71比0.68)。结论:术前CEA水平升高的Ⅰ~Ⅲ期结肠癌患者术后发生癌症特异性死亡的风险更高,术前CEA水平升高是Ⅰ~Ⅲ期结肠癌患者不良预后的独立危险因素。
Objective:To investigate the effect of preoperative elevated carcinoembryonic antigen(CEA)level on the prognosis of patients with stage Ⅰ-Ⅲ colon cancer.Methods:The clinical data of stageⅠ-Ⅲcolon cancer patients who underwent radical surgery from 2010 to 2015 in SEER database were retrospectively analyzed.According to the preoperative CEA level,patients were divided into the normal group(≤5.0 ng/mL)and the elevated group(>5.0 ng/mL).Kaplan-Meier method was used to estimate the cancer specific survival(CSS).Logrank test was used to evaluate the survival difference between two groups.Cox regression model was used to analyze the prognostic effect of preoperative CEA level on stageⅠ-Ⅲcolon cancer patients.A nomogram prediction model of American Joint Committee on Cancer(AJCC)stage combined with preoperative CEA level was established and the discrimination of the model was analyzed.Results:A total of 17921 patients were included,11467 patients(64.0%)with normal preoperative CEA level and 6454 patients(36.0%)with elevated CEA level.The median follow-up time was 45 months(29-66)and 2910 patients(16.24%)died of colon cancer during the last follow-up.The overall 5-year cancer specific survival rate was 81.48%(95%CI:80.82%-82.14%).Patients with elevated preoperative CEA level had later AJCC stage,lower differentiation degree and more prone to peripheral nerve infiltration.The 5-year CSS rate of patients with elevated group and normal group was 72.75%and 86.25%,respectively(P<0.001).Multivariate Cox regression analysis showed that elevated preoperative CEA level were independently associated with shorter CSS(HR=1.74,95%CI:1.62-1.88,P<0.001).The AUC of AJCC stage combined with preoperative CEA level nomogram prediction model was higher than that of AJCC stage model alone(0.71 vs 0.68).Conclusion:Patients with elevated preoperative CEA level have a higher risk of cancer-specific death,and elevated preoperative CEA level is an independent risk factor for poor prognosis in patients with stageⅠ-Ⅲcolon cancer。
作者
杜昆
杜宁超
刘安文
廖木春
陈小岚
DU Kun;DU Ningchao;LIU Anwen;LIAO Muchun;CHEN Xiaolan(Shantou University Medical College,Shantou 515041,China;Department of Anorectal Surgery,Shenzhen Second People's Hospital,Shenzhen 518035,China;Department of Gastrointestinal Surgery,Shenzhen Second People's Hospital,Shenzhen 518035,China)
出处
《汕头大学医学院学报》
2021年第3期136-142,共7页
Journal of Shantou University Medical College
关键词
结肠癌
癌胚抗原
生存分析
危险因素
colon cancer
carcinoembryonic antigen
survival analysis
risk factors
