| 摘要: |
| 目的：探讨不同AFP表达状态下的胃癌患者血清中CEA的表达差异及临床意义。方法：选取2012年1月-2017年12月昆明医科大学第三附属医院收治的346例胃癌患者的临床资料,将患者分为AFP阳性胃癌(AFPGC)和AFP阴性胃癌(non-AFPGC)两组,通过卡方检验或Fiher’s确切概率法分析两组患者临床病理特征和血清CEA等肿瘤标志表达差异,通过Kaplan-Meier法分析两组患者生存差异。根据CEA的表达,将上述两组患者分别分为CEA正常组和异常组两个亚组,并完善两亚组患者临床病理特征；血清CA125、CA199和CA724等表达差异分析和生存差异分析。结果：AFPGC患者28例,占总患者数8.12%。AFPGC和non-AFPGC两组患者年龄、性别、T、N、M、临床病理分期、肿瘤细胞分化程度、病理类型等指标分布无明显差异(P > 0.05),总生存无明显差异(P = 0.3386),在此基础上发现,AFPGC组CEA高表达患者数(14/28,50%)显著高于non-AFPGC患者数(96/318,30.19%)(χ2 = 4.685,P = 0.031)。在AFPGC患者中,CEA异常表达和正常表达两组患者年龄、性别、T、N、M、临床病理分期、肿瘤细胞分化程度、病理类型及肿瘤标志的表达等指标无明显差异(P > 0.05),CEA的表达差异不影响AFPGC患者总体生存(P = 0.6050)。在non-AFPGC患者中,CEA异常表达组患者男性(P = 0.002)；T3/4(P = 0.01),N(+)(P = 0.038),III/IV期(P = 0.009)、CA199(P < 0.001)和CA724(P < 0.001)异常表达患者数均显著高于CEA 正常组患者,且总生存显著低于CEA低表达患者(P = 0.0243)。结论：AFPGC患者CEA表达高于non-AFPGC患者,CEA的表达差异并不影响两组患者总体生存。CEA的高表达可提示non-AFPGC患者伴随异常高表达的CA199和CA724,具有更差的T、N、临床分期和生存预后。该结论对建立基于AFP和CEA联合检测的胃癌亚组分型、临床预后指导、化疗策略抉择和疗效预测有一定的指导意义。 |
| 关键词: 胃癌 AFP CEA 临床病理特征 生存预后 |
| DOI： |
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| 基金项目:云南省基础研究计划（昆医联合专项） |
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| Expression of CEA in serum of gastric cancer patients with different AFP expression and its clinical significance |
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Luan Likun
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The Third Affiliated Hospital of Kunming Medical University
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| Abstract: |
| OBJECTIVE: To investigate the expression of CEA in gastric cancer (GC) patients under different AFP status and its clinical significance. Methods: The clinical data of 346 patients with GC admitted to The Third Affiliated Hospital of Kunming Medical University from January 2012 to December 2017 were retrospectively analyzed. Patients were divided into two groups: AFP-positive gastric cancer (AFPGC) and AFP-negative gastric cancer (non-AFPGC). The clinicopathological characteristics, CEA and other tumor marker expressions were compared between the two groups by Chi-square test or Fisher"s exact probability method, overall survival was compared by Kaplan-Meier method. According to the expression of CEA, the above two groups of patients were divided into two subgroups, CEA normal group and CEA abnormal group, the clinicopathological characteristics, CA125, CA199 and CA724 expression, and overall survival were compared between the two subgroups. Results: There were 28 AFPGC patients, accounting for 8.12% of the total number of patients. The AFPGC and non-AFPGC groups showed no significant difference in the age, gender, T, N, M, clinicopathological stage, tumor cell differentiation, pathological type (P > 0.05), and overall survival (P = 0.3386). Patients with high CEA expression in the AFPGC group (14/28, 50%) was significantly higher than that in non-AFPGC group (96/318, 30.19%) (χ2 = 4.685, P = 0.031). In AFPGC patients, there was no significant difference in age, gender, T, N, M, clinicopathological stage, tumor cell differentiation, pathological type, and the expression of tumor markers between the CEA normal and abnormal groups (P > 0.05) , CEA expression did not affect the overall survival in AFPGC patients (P = 0.6050). In non-AFPGC patients, the number of the patients with male (P = 0.002); T3/4 (P = 0.01), N (+) (P = 0.038), stage III/IV (P = 0.009), CA199, CA724 (P <0.001) and CA724 (P <0.001) was significantly higher in CEA abnormal group than those in CEA normal group (P = 0.0243). Conclusion: The expression of CEA in AFPGC patients is higher than that in non-AFPGC patients, the expression CEA do not affect the overall survival between the two groups. The high expression of CEA can indicate that non-AFPGC patients with abnormally high expression of CA199 and CA724, worse T, N, clinical stage and survival prognosis. This conclusion has certain guiding significance for the establishment of gastric cancer sub-types based on the combined detection of AFP and CEA, clinical prognosis guidance, chemotherapy strategy selection and efficacy prediction. |
| Key words: Gastric Cancer AFP CEA Clinicopathological Characteristics Survival Prognosis |
