本文關(guān)鍵詞： CEA CA199 結(jié)直腸癌 預(yù)后 復(fù)發(fā)　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討圍手術(shù)期CEA、CA199及其比值對(duì)結(jié)直腸癌術(shù)后預(yù)后的價(jià)值。方法回顧分析于2012年9月至2014年9月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院病理確診為結(jié)直腸癌并接受手術(shù)治療及符合納入標(biāo)準(zhǔn)的231例結(jié)直腸癌患者。分別于術(shù)前、術(shù)后1-2周利用化學(xué)發(fā)光法檢測(cè)術(shù)前血清CEA、CA199水平和術(shù)后血清CEA、CA199水平,及計(jì)算出CEA ratio、CA199ratio。c2檢驗(yàn)分別分析上述六個(gè)觀察指標(biāo)與結(jié)直腸癌患者臨床病理參數(shù)的關(guān)系,Kaplan-Meier生存曲線分別分析上述六個(gè)觀察指標(biāo)與結(jié)直腸癌生存預(yù)后的關(guān)系,COX回歸模型多因素分析影響結(jié)直腸癌術(shù)后預(yù)后的因素。結(jié)果(1)c2檢驗(yàn)顯示術(shù)前血清CEA陽(yáng)性在腫瘤遠(yuǎn)處轉(zhuǎn)移(P=0.029)、TNM分期(P=0.031)中的差異具有統(tǒng)計(jì)學(xué)意義。術(shù)前血清CA199陽(yáng)性在腫瘤浸潤(rùn)深度(P=0.023)、淋巴結(jié)轉(zhuǎn)移(P=0.003)、TNM分期(P=0.000)、組織分化程度(P=0.035)中的差異具有統(tǒng)計(jì)學(xué)意義。術(shù)后血清CEA陽(yáng)性在腫瘤遠(yuǎn)處轉(zhuǎn)移(P=0.003)、TNM分期(P=0.016)中的差異具有統(tǒng)計(jì)學(xué)意義。術(shù)后血清CA199陽(yáng)性在腫瘤遠(yuǎn)處轉(zhuǎn)移(P=0.027)、淋巴結(jié)轉(zhuǎn)移(P=0.004)、TNM分期(P=0.000)中的差異具有統(tǒng)計(jì)學(xué)意義。CEAratio、CA199ratio與所統(tǒng)計(jì)的臨床病理參數(shù)間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)Kaplan-Meier生存曲線分析表明,相比術(shù)前CEA陰性的患者,術(shù)前CEA陽(yáng)性與結(jié)直腸癌術(shù)后總生存期無(wú)顯著相關(guān)性(P=0.122);與術(shù)后CEA陰性、術(shù)前/術(shù)后CA199陰性、CEA ratio1、CA199 ratio1的患者相比,術(shù)后CEA陽(yáng)性、術(shù)前/術(shù)后CA199陽(yáng)性、CEA ratio1、CA199ratio1的患者的3年總生存期均明顯縮短(P0.05)。(3)COX回歸模型多因素分析顯示術(shù)前血清CA199陽(yáng)性、CEA ratio1、CA199ratio1、淋巴結(jié)轉(zhuǎn)移、腫瘤遠(yuǎn)處轉(zhuǎn)移為結(jié)直腸癌術(shù)后預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論1、術(shù)前血清CA199陽(yáng)性是結(jié)直腸癌術(shù)后預(yù)后的獨(dú)立危險(xiǎn)因素,術(shù)前或術(shù)后血清CEA水平與淋巴結(jié)轉(zhuǎn)移、TNM分期等病理因素有關(guān),但不是結(jié)直腸癌術(shù)后預(yù)后的獨(dú)立危險(xiǎn)因素。2、CEA ratio1、CA199 ratio1可能是結(jié)直腸癌術(shù)后預(yù)后不良的獨(dú)立危險(xiǎn)因素之一,但需要加大樣本量來(lái)進(jìn)一步研究證實(shí)。
[Abstract]:Objective to investigate the value of CEACA199 and its ratio in postoperative prognosis of colorectal cancer during perioperative period. Methods from September 2012 to September 2014, we retrospectively analyzed the pathologically diagnosed colorectal cancer and received surgical treatment in the first affiliated Hospital of Guangxi Medical University. All 231 patients with colorectal cancer who met the inclusion criteria were treated preoperatively. At 1-2 weeks after operation, chemiluminescence assay was used to detect the serum levels of CEACA199 before and after operation. The relationship between the above six observation indexes and the clinicopathological parameters of colorectal cancer patients was calculated by CEA ratio.c2 test. Kaplan-Meier survival curve was used to analyze the relationship between the above six observation indexes and the survival prognosis of colorectal cancer respectively and Cox regression model was used to analyze the relationship between the above six indexes and the prognosis of colorectal cancer. Multivariate analysis of the prognostic factors of postoperative colorectal cancer. Results the preoperative serum CEA positive was significantly different in the distant metastasis of tumor P0. 029. The preoperative serum CA199 was positive in the depth of tumor invasion. There were significant differences in the levels of CEA in the patients with lymph node metastasis (P 0.003) and in the stage of TNM (P 0. 000, P 0. 035). There was a significant difference in the expression of serum CEA in the patients with distant metastasis (P 0. 003) and the positive rate of serum CA199 in the patients with distant tumor metastasis (P 0. 016) after operation, there was a significant difference in the level of serum CA199 in the patients with distant metastasis of the tumor (P < 0. 003 or P 0. 016). There was no significant difference between P0. 027, P0. 004, TNM staging and P0. 000). There was no significant difference between the CA ratio of CEAratiografts and the clinicopathologic parameters. The analysis of survival curve of P0. 05 and Kaplan-Meier showed that there was no significant difference between P0. 05 and P0. 004. There was no significant correlation between preoperative CEA positive and total postoperative survival time of colorectal cancer compared with preoperative CEA negative patients, but no significant correlation between preoperative CEA positive and postoperative CEA negative CA199 negative CEA ratio1 CA199 ratio1. The 3-year total survival time of the patients with CA199 positive CA199 / CA199ratio1 was significantly shortened by multivariate analysis of multivariate regression model (P0.05). The results of multivariate analysis showed that the preoperative serum CA199 positive patients with CEA ratio1 / CA199ratio1 had lymph node metastasis. Conclusion 1. Preoperative serum CA199 positive is an independent risk factor for postoperative prognosis of colorectal cancer. Preoperative or postoperative serum CEA levels are associated with pathological factors such as lymph node metastasis and TNM staging. But it is not an independent risk factor for postoperative prognosis of colorectal cancer. 2CEA ratio1 CA199 ratio1 may be one of the independent risk factors for poor prognosis of colorectal cancer.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.34

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