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背景与目的:癌胚抗原(carcinoembryonic antigen,CEA)监测在指导恶性肿瘤特别是结直肠癌的治疗中起重要作用。CEA半衰期作为一个较新的指标,也被应用于恶性肿瘤的监测。本研究通过检测结直肠患者术前和术后短期内的CEA水平,并计算CEA半衰期,以判断将它作为预后因素的可能性。方法:回顾性选取98例术前CEA水平升高(≥5μg/L)并有常规的术后早期CEA监测的结直肠癌根治术后患者作为研究对象。计算术后CEA半衰期,并分析它与预后的关系。结果:98例患者中,21例发生复发或远处转移,77例无复发转移。复发组术前CEA中位值(23.9μg/L)显著高于未复发组(12.3μg/L)(P=0.010);复发组术后CEA半衰期中位值为6.2天,显著长于未复发组(4.7天)(P=0.042);疾病分期越晚,预后越差(P<0.001)。术后CEA半衰期较短的患者与半衰期较长的患者相比,3年无病生存率(87%vs.66%,P=0.017)和3年总生存率(90%vs.80%,P=0.032)都较高;TNM分期较早的患者无病生存率和总生存率均较高,Ⅰ、Ⅱ、Ⅲ期患者的3年无病生存率分别为100%、93%和55%(P<0.001),3年总生存率分别为100%、98%和77%(P=0.192)。Cox回归分析表明,TNM分期和术后CEA半衰期是术前CEA水平升高的结直肠癌患者的独立预后因素。结论:除TNM分期外,CEA半衰期也可作为术前CEA水平升高的结直肠癌患者的独立预后因素。根治术后CEA半衰期延长的患者预后较差。
BACKGROUND & AIM: Surveillance of carcinoembryonic antigen (CEA) plays an important role in the treatment of malignant tumors, especially colorectal cancer. As a newer indicator of CEA half-life, it has also been used to monitor malignancy. In this study, the CEA level in preoperative and postoperative short-term colorectal cancer patients was measured and the CEA half-life was calculated to determine the possibility of using it as a prognostic factor. Methods: We retrospectively selected 98 patients with colorectal cancer who underwent radical prostatectomy who had elevated preoperative CEA level (≥ 5 μg / L) and had conventional postoperative CEA monitoring. The postoperative CEA half-life was calculated and its relationship to prognosis was analyzed. Results: Among the 98 patients, 21 cases had recurrence or distant metastasis, and 77 cases had no recurrence and metastasis. The median preoperative CEA (23.9 μg / L) in the recurrent group was significantly higher than that in the non-recurrent group (P = 0.010). The median CEA half-life in the recurrent group was 6.2 days, significantly longer than that in the non-recurrent group (4.7 days) (P = 0.042); the later the disease stage, the poorer the prognosis (P <0.001). The 3-year disease-free survival (87% vs. 66%, P = 0.017) and 3-year overall survival (90% vs. 80%, P = 0.032). The 3-year disease-free survival rates of patients with stage I, II and III were 100%, 93% and 55%, respectively P <0.001). The 3-year overall survival rates were 100%, 98% and 77%, respectively (P = 0.192). Cox regression analysis showed that TNM stage and postoperative CEA half-life were independent prognostic factors for patients with colorectal cancer with elevated CEA levels before surgery. CONCLUSION: In addition to the TNM stage, the half-life of CEA may also be an independent prognostic factor in patients with colorectal cancer with elevated CEA levels before surgery. Patients with a longer CEA half-life after radical surgery have a worse prognosis.