引用本文:栾利昆,代佑果,杨昌龙,刘 珊,刘 欣,嘉俊毅,韩 潇,程先硕.不同AFP表达状态胃癌患者血清CEA水平差异及其临床意义分析[J].中国临床新医学,2022,15(6):517-522.
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不同AFP表达状态胃癌患者血清CEA水平差异及其临床意义分析
栾利昆,代佑果,杨昌龙,刘 珊,刘 欣,嘉俊毅,韩 潇,程先硕
650118 云南,昆明医科大学第三附属医院(云南省肿瘤医院)普通外科
摘要:
[摘要] 目的 分析不同甲胎蛋白(AFP)表达状态胃癌患者血清癌胚抗原(CEA)的表达水平差异及其临床意义。方法 回顾性分析昆明医科大学第三附属医院2012年1月至2017年12月连续收治的346例原发性胃癌患者的临床资料,将其分为AFP阳性胃癌(AFPGC)组(AFP≥7 μg/L,28例)和AFP阴性胃癌(non-AFPGC)组(AFP<7 μg/L,318例),并进一步分层为CEA正常组(CEA<3.4 μg/L)和CEA升高组(CEA≥3.4 μg/L)。比较各分组间的临床病理特征及生存预后情况。结果 AFPGC组和non-AFPGC组在年龄、性别、T分期、N分期、M分期、临床病理分期、肿瘤细胞分化程度、肿瘤细胞病理类型等方面比较差异无统计学意义(P>0.05)。两组肿瘤标志物CA125、CA199和CA724表达情况差异无统计学意义(P>0.05)。AFPGC组CEA≥3.4 μg/L的人数比例高于non-AFPGC组,差异有统计学意义(P<0.05)。AFPGC组和non-AFPGC组的中位生存时间分别为30个月和31个月,两组生存预后比较差异无统计学意义(log-rank: χ2=0.723,P=0.395)。在AFPGC患者中,CEA升高组除了男性比例显著高于CEA正常组外,其余临床病理特征指标比较差异无统计学意义(P>0.05),两组生存预后情况差异亦无统计学意义(log-rank: χ2=0.267,P=0.605)。在non-AFPGC患者中,CEA升高组中男性、T分期为T3~4期、N分期为N(+)期、临床病理分期为Ⅲ~Ⅳ期,以及CA199≥27 ku/L、CA724≥6.9 ku/L的人数比例高于CEA正常组,差异有统计学意义(P<0.05)。CEA升高组和CEA正常组的中位生存时间分别为24个月和34个月,两组生存预后差异有统计学意义(log-rank: χ2=6.658,P=0.001)。结论 建立基于AFP、CEA联合检测的胃癌亚组分型对临床治疗方案选择及疗效预测有一定的临床意义。
关键词:  胃癌  甲胎蛋白  癌胚抗原  临床病理特征  生存预后
DOI:10.3969/j.issn.1674-3806.2022.06.09
分类号:R 735.2
基金项目:云南省科技计划项目[编号:2018FE001(-064)]
Analysis on the differences of serum CEA levels in gastric cancer patients with different AFP expression states and their clinical significances
LUAN Li-kun, DAI You-guo, YANG Chang-long, et al.
Department of General Surgery, the Third Affiliated Hospital of Kunming Medical University(Yunnan Cancer Hospital), Yunnan 650118, China
Abstract:
[Abstract] Objective To analyze the differences and clinical significances of serum carcino-embryonic antigen(CEA) expression levels in gastric cancer patients with different alpha fetoprotein(AFP) expression states. Methods The clinical data of 346 patients with primary gastric cancer who were consecutively admitted to the Third Affiliated Hospital of Kunming Medical University from January 2012 to December 2017 were retrospectively analyzed. The patients were divided into AFP-positive gastric cancer(AFPGC) group(AFP≥7 μg/L, 28 cases) and AFP-negative gastric cancer(non-AFPGC) group(AFP<7 μg/L, 318 cases), and were further stratified into normal CEA group(CEA<3.4 μg/L) and CEA elevated group(CEA≥3.4 μg/L). The clinicopathological characteristics and survival prognosis were compared between different divided groups. Results There were no significant differences between the AFPGC group and the non-AFPGC group in age, gender, T stage, N stage, M stage, clinicopathological stage, tumor cell differentiation degree, and tumor cell pathological type(P>0.05).There were no significant differences in the expressions of tumor markers of CA125, CA199 and CA724 between the two groups(P>0.05). The proportion of the patients with CEA≥3.4 μg/L in the AFPGC group was significantly higher than that in the non-AFPGC group(P<0.05). The median survival time was 30 months and 31 months in the AFPGC group and the non-AFPGC group, respectively, and there was no significant difference in survival prognosis between the two groups(log-rank: χ2=0.723, P=0.395). In the AFPGC patients, except that the proportion of the male patients in the elevated CEA group was significantly higher than that in the normal CEA group, there were no significant differences in the other indicators of clinicopathological characteristics(P>0.05), and there was no statistically significant difference in the survival prognosis between the two groups(log-rank: χ2=0.267, P=0.605). In the non-AFPGC patients, the proportions of male patients and the proportions of the patients with T stage of T3~4, N stage of N(+), clinicopathological stage of Ⅲ-Ⅳ, and CA199≥27 ku/L and CA724≥6.9 ku/L in the elevated CEA group were higher than those in the normal CEA group, and the differences were statistically significant(P<0.05). The median survival time was 24 months and 34 months in the elevated CEA group and the normal CEA group, respectively, and the difference in survival prognosis between the two groups was statistically significant(log-rank: χ2=6.658, P=0.001). Conclusion The establishment of gastric cancer subtypes based on the combined detection of AFP and CEA has certain clinical significance for clinical treatment options and efficacy prediction.
Key words:  Gastric cancer  Alpha fetoprotein(AFP)  Carcino-embryonic antigen(CEA)  Clinicopathological feature  Survival prognosis