传统肿瘤标记物预测胃癌新辅助化疗疗效的研究

Study on Prediction of Neoadjuvant Chemotherapy Efficacy of Traditional Tumor Markers in Gastric Cancer

摘要: 目的：分析传统肿瘤标记物预测胃癌新辅助化疗疗效的研究。方法：回顾性分析90例接受新辅助化疗胃癌患者的临床病理资料，记录患者新辅助化疗前后CEA、CA199、CA724的表达水平，并在新辅助化疗和手术结束后根据recist1.1评分标准将患者分为疾病控制组(CR + PR + SD)和疾病进展组(PD)，根据Ryan标准将患者分为病理完全退缩组(pCR)和非病理完全退缩组(Non-pCR)。分别分析CEA、CA199、CA724在新辅助化疗前水平和化疗前后变化量对胃癌新辅助化疗疗效和病理完全缓解率的预测。结果：CEA阳性率与肿瘤的分化程度、淋巴结转移、疾病进展有关。CA724与肿瘤大小、TNM分期等因素相关。3种肿瘤标记物联合检测阳性与淋巴结转移、分化程度密切相关。CEA化疗前高水平对疾病进展可能具有预测作用(AUC = 682, 95%CI: 0.549~0.815, P = 0.010)，最大化该试验的灵敏度(52.2%)和特异性(83.6%)的临界值为17.65 ng/ml。新辅助化疗后3种传统肿瘤标记物的水平较化疗前下降，CA724的降低量可能具有预测疾病控制的作用(AUC = 0.749, 95%CI: 0.550~0.947, P = 0.047)，同时使试验的灵敏度(56.0%)和特异性(85.7%)最大化的最佳截止值降低了64.0%。CA199化疗前水平对非病理完全缓解可能具有预测作用(AUC = 0.740, 95%CI: 0.538~0.942, P = 0.036)，最大化该试验的灵敏度(74.7%)和特异性(85.7%)的临界值为6.89 U/ml。CA724的降低量对病理完全缓解可能具有预测作用(AUC = 0.933, 95%CI: 0.839~1.000, P = 0.043)，同时使试验的灵敏度(100%)和特异性(90.0%)最大化的最佳截止值降低了90.6%。结论：CEA、CA199、CA724可能对胃癌新辅助化疗的疗效和病理反应具有预测作用，对于胃癌的新辅助化疗可能具有指导作用。

Abstract: Objective: To analyze the efficacy of traditional tumor markers in predicting neoadjuvant chemotherapy for gastric cancer. Methods: The clinicopathological data of 90 patients with gastric cancer who received neoadjuvant chemotherapy were retrospectively analyzed. The expression levels of CEA, CA199, and CA724 before and after neoadjuvant chemotherapy were recorded. After neoadjuvant chemotherapy and surgery, the patients were divided according to the recest1.1 scoring standard. For the disease control group (CR + PR + SD) and the disease progression group (PD), patients were divided into pathological complete remission group (pCR) and non-pathological complete remission group (Non-pCR) according to Ryan standard. The levels of CEA, CA199, and CA724 before and after neoadjuvant chemotherapy were analyzed respectively to predict the efficacy of neoadjuvant chemotherapy and pathological complete remission rate for gastric cancer. Results: The positive rate of CEA is related to the degree of tumor differentiation, lymph node metastasis, and disease progression. CA724 is related to tumor size, TNM stage and other factors. The positive combined detection of the three tumor markers is closely related to the degree of lymph node metastasis and differentiation. The high level of CEA before chemotherapy may have a predictive effect on disease progression (AUC = 682, 95%CI: 0.549~0.815, P = 0.010), maximizing the critical value of the sensitivity (52.2%) and specificity (83.6%) of the test, it is 17.65 ng/ml. The levels of the three traditional tumor markers after neoadjuvant chemotherapy were lower than before chemotherapy. The reduction of CA724 may have a predictive effect on disease control (AUC = 0.749, 95%CI: 0.550~0.947, P = 0.047). The optimal cutoff value for maximizing sensitivity (56.0%) and specificity (85.7%) is reduced by 64.0%. The level of CA199 before chemotherapy may have a predictive effect on non-pathological complete remission (AUC = 0.740, 95%CI: 0.538~0.942, P = 0.036), maximizing the sensitivity (74.7%) and specificity (85.7%) of the test, the value is 6.89 U/ml. The reduction of CA724 may have a predictive effect on pathological complete remission (AUC = 0.933, 95%CI: 0.839~1.000, P = 0.043), while maximizing the sensitivity (100%) and specificity (90.0%) of the test, the best cut-off value is reduced by 90.6%. Conclusion: CEA, CA199, and CA724 may have predictive effects on the efficacy and pathological response of neoadjuvant chemotherapy for gastric cancer, and may have a guiding role for neoadjuvant chemotherapy for gastric cancer.