Preoperative serum markers for individual patient prognosis in stage I-III colon cancer
Preoperative serum markers for individual patient prognosis in stage I-III colon cancer
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DOI：
10.1007/s13277-015-3522-z
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发表时间：
2015-09-01
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影响因子：
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通讯作者：
Stieber, Petra
中科院分区：
文献类型：
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作者：
Giessen-Jung, Clemens;Nagel, Dorothea;Stieber, Petra
癌胚抗原（CEA）仍然是唯一推荐用于结直肠癌（CRC）随访护理的生物标志物，但除了CEA，其他几个血清学参数已被提出作为CRC的预后标志物。本回顾性分析研究了一组关于癌症特异性生存期（CSS）和无病生存期（DFS）的综合血清标志物。1988年1月至2007年6月期间，共有472例结肠癌患者接受了根治性手术。分析术前血清的以下参数：白蛋白、碱性磷酸酶（aP）、β-人绒毛膜促性腺激素（β hCG）、胆红素、癌抗原125（CA 125）、癌抗原19-9（CA 19-9）、CA 72-4、CEA、C-反应蛋白（CRP）、细胞角蛋白-19可溶性片段（CYFRA 21-1）、铁蛋白、γ-谷氨酰转移酶（γ GT）、谷氨酸草酰乙酸转氨酶（GOT）、谷氨酸丙酮酸转氨酶（GPT）、血红蛋白、触珠蛋白、白细胞介素-6、白细胞介素-8、肌酸酐、乳酸脱氢酶（LDH）、血清淀粉样蛋白A（SAA）、和25-羟基维生素D。中位随访期为5.9年后，总体3年和5年CSS分别为91.7%和84.9%，DFS率分别为82.7%（3年）和77.6%（5年）。多变量分析证实术前CEA是CSS和DFS的独立预后因素。CA 19-9和γ GT也分别提供CSS和DFS的预后价值。年龄较小与DFS呈负相关。根据UICC分期，CEA对CSS和DFS具有重要的预后价值，而CA 19-9仅对CSS具有预后价值。联合分析能够识别预后良好的患者。除肿瘤基线参数外，术前CEA可作为结肠癌的预后标志物。CA 19-9和γ GT还分别提供关于III期和I期疾病的存活和复发的额外预后价值。CEA与CA 19-9和γ GT的联合使用改善了风险适应性术后监测。
Carcinoembryonic antigen (CEA) remains the only recommended biomarker for follow-up care of colorectal cancer (CRC), but besides CEA, several other serological parameters have been proposed as prognostic markers for CRC. The present retrospective analysis investigates a comprehensive set of serum markers with regard to cancer-specific survival (CSS) and disease-free survival (DFS). A total of 472 patients with colon cancer underwent surgery for curative intent between January 1988 and June 2007. Preoperative serum was analyzed for the following parameters: albumin, alkaline phosphatase (aP), beta-human chorionic gonadotropin (beta hCG), bilirubin, cancer antigen 125 (CA 125), cancer antigen 19-9 (CA 19-9), CA 72-4, CEA, C-reactive protein (CRP), cytokeratin-19 soluble fragment (CYFRA 21-1), ferritin, gamma-glutamyltransferase (gamma GT), glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), hemoglobin, haptoglobin, interleukin-6, interleukin-8, creatinine, lactate dehydrogenase (LDH), serum amyloid A (SAA), and 25-hydroxyvitamin D. After a median follow-up period of 5.9 years, the overall 3- and 5-year CSS was 91.7 and 84.9 % and DFS rates were 82.7 % (3 years) and 77.6 % (5 years). Multivariate analyses confirmed preoperative CEA as an independent prognostic factor with regard to CSS and DFS. CA 19-9 and gamma GT also provided prognostic value for CSS and DFS, respectively. Younger age was negatively associated with DFS. According to UICC stage, CEA provided significant prognostic value with regard to CSS and DFS, while CA 19-9 was only prognostic for CSS. Combined analysis is able to identify patients with favorable prognosis. In addition to tumor baseline parameters, preoperative CEA could be confirmed as prognostic marker in colon cancer. CA 19-9 and gamma GT also provide additional prognostic value with regard to survival and recurrence in stage III and stage I disease, respectively. The combined use of CEA together with CA 19-9 and gamma GT improve risk-adapted post-op surveillance.