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目的探讨术前血清CEA和CA19-9水平在胃癌根治术后复发转移及预后中的应用价值。方法应用电化学发光法检测136例胃癌患者术前静脉血清CEA和CA19-9水平,分析CEA和CA19-9水平与患者临床病理学参数、术后复发转移和预后的关系。采用Kaplan-Meier法(log-rank检验)进行生存分析。结果 136例胃癌患者中术后复发转移67例。术前血清CEA阳性率为48.5%(66/136),CA19-9阳性率为43.4%(59/136)。CEA阳性与T分期、TNM分期、淋巴结转移及脉管浸润有关(P=0.011、P=0.018、P=0.021、P=0.024),CA19-9阳性与T分期和淋巴结转移有关(P=0.018、P=0.045)。CEA阳性组和CA19-9阳性组术后复发转移率分别为60.6%(40/66)和61.0%(36/59),CEA阴性组和CA19-9阴性组术后复发转移率分别为38.6%(27/70)和40.3%(31/77),CEA阳性组和CA19-9阳性组术后复发转移率分别明显高于CEA阴性组和CA19-9阴性组(P=0.010、P=0.016)。Kaplan-Meier生存分析显示CEA阳性组和CA19-9阳性组术后无瘤生存时间明显短于CEA阴性组和CA19-9阴性组(P=0.003、P=0.007)。结论术前血清CEA和CA19-9水平检测在胃癌术后复发转移和预后判断中具有重要价值,术前联合检测血清CEA和CA19-9水平有助于提高胃癌术后复发转移和预后的预测。
Objective To investigate the value of preoperative serum CEA and CA19-9 in the recurrence, metastasis and prognosis of gastric cancer after radical operation. Methods The levels of CEA and CA19-9 in 136 patients with gastric cancer before operation were measured by electrochemiluminescence. The relationship between CEA and CA19-9 levels and clinicopathological parameters, recurrence, metastasis and prognosis were analyzed. Survival analysis was performed using the Kaplan-Meier method (log-rank test). Results Of the 136 gastric cancer patients, 67 cases had recurrence and metastasis. Preoperative serum CEA positive rate was 48.5% (66/136), CA19-9 positive rate was 43.4% (59/136). CEA positive was related to T stage, TNM stage, lymph node metastasis and vascular invasion (P = 0.011, P = 0.018, P = 0.021, P = 0.024) P = 0.045). The recurrence and metastasis rates of CEA positive group and CA19-9 positive group were 60.6% (40/66) and 61.0% (36/59) respectively. The recurrence and metastasis rates of CEA negative group and CA19-9 negative group were 38.6% (27/70) and 40.3% (31/77) respectively. The postoperative recurrence and metastasis rates of CEA positive group and CA19-9 positive group were significantly higher than those of CEA negative group and CA19-9 negative group (P = 0.010, P = 0.016) . Kaplan-Meier survival analysis showed that tumor-free survival time was significantly shorter in CEA-positive group and CA19-9-positive group than in CEA-negative group and CA19-9-negative group (P = 0.003, P = 0.007). Conclusions Preoperative serum levels of CEA and CA19-9 are of great value in the postoperative recurrence, metastasis and prognosis of gastric cancer. Preoperative combination of serum CEA and CA19-9 levels may be helpful to predict the recurrence, metastasis and prognosis of gastric cancer.