术前血清CA19-9和NSE对食管鳞癌患者预后的影响

相智声; 林征; 刘双; 杨惠敏; 王航; 黄丽萍; 陈元美; 胡志坚

doi:10.16462/j.cnki.zhjbkz.2019.02.003

术前血清CA19-9和NSE对食管鳞癌患者预后的影响

doi: 10.16462/j.cnki.zhjbkz.2019.02.003

1.
350122 福州, 福建医科大学公共卫生学院流行病与卫生统计学系, 福建省环境因素与肿瘤省级重点实验室
2.
350014 福州, 医科大学教学医院, 福建省肿瘤医院胸外科

基金项目:

国家重点研发计划精准医学研究重点专项2017年度项目 2017YFC0907100

2018年福建省医学创新课题 2018-CX-38

详细信息

通讯作者:
胡志坚, E-mail: hzj99955888@126.com

中图分类号: R449
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出版历程
- 收稿日期: 2018-08-14
- 修回日期: 2018-11-06
- 刊出日期: 2019-02-10

Prognostic values of preoperative serum CA199 and NSE on esophageal squamous cell carcinoma patients

1.
Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
2.
Department of Thoracic surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University; Fuzhou 350014, China

Funds:

National Key R&D Program of China 2017YFC0907100

Medical Innovation project of Fujian Province 2018-CX-38

More Information

Corresponding author: Hu Zhi-jian, E-mail: hzj99955888@126.com

摘要

摘要: 目的研究术前血清癌抗原19-9（cancer antigen 19-9，CA19-9）和神经元特异性烯醇化酶（neuron-specific enolase，NSE）对食管鳞癌（esophageal squamous cell carcinoma，ESCC）患者预后的影响。方法前瞻性分析176例经病理确诊的食管鳞癌新发病例。应用χ²检验分析CA19-9和NSE与患者一般临床特征之间的关系。运用Kaplan-Meier法绘制生存曲线，通过Log-rank法进行生存率的比较，利用Cox比例风险回归模型进行多因素分析。结果高CA19-9和NSE联合检测组的食管鳞癌患者预后较差（总生存：HR=2.310，95%CI：1.209~4.418；无病生存：HR=2.354，95%CI：1.265~4.381）。相比于两种标志物单独检测，联合检测CA19-9和NSE对食管鳞癌患者生存预测的准确性更高（总生存：C-index=0.686；无病生存：C-index=0.684）。结论术前血清CA19-9和NSE是食管鳞癌患者预后的危险因素，联合检测对食管鳞癌患者预后预测的准确性更高。
- 食管鳞癌 /
- 癌抗原19-9 /
- 神经元特异性烯醇化酶 /
- 预后
Abstract: Objective To explore the effects of preoperative serum cancer antigen 19-9 (CA19-9) and neuron-specific enolase (NSE) on the prognosis of patients with esophageal squamous cell carcinoma (ESCC). Methods This prospective study enrolled 176 patients with ESCC. χ² test was used to analyze the relationship between CA19-9, NSE and general clinical features. Survival curves were estimated using Kaplan-Meier method and comparisons were performed using the log-rank test. The Cox proportional hazards model was performed for multivariate analyses of overall survival (OS) and disease free survival (DFS). Results The patients with both high CA19-9 and NSE had the poor prognosis compared with those had both low CA19-9 and NSE (OS: HR=2.310, 95% CI: 1.208-4.418; DFS: HR=2.354, 95% CI: 1.265-4.381). Compared to the separate detection of the two markers, the combined detection of CA19-9 and NSE was more accurate in the prognosis prediction of patients with ESCC (OS: C-index=0.686; DFS: C-index=0.684). Conclusions Preoperative serum CA19-9 and NSE were risk factors for the prognosis of patients with ESCC. Combined detection had higher accuracy of prediction of prognosis in patients with ESCC.
- Esophageal squamous cell carcinoma /
- Cancer antigen 19-9 /
- Neuron-specific enolase /
- Prognostic

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图 1 不同CA19-9和NSE联合检测分组患者的总生存曲线

Figure 1. Overall survival curves of patients in different groups of the the combined detection CA19-9 and NSE

下载: 全尺寸图片幻灯片

图 2 不同CA19-9和NSE联合检测分组患者的无病生存曲线

Figure 2. Disease free survival curves of patients in different groups of the the combined detection of of CA19-9 and NSE

下载: 全尺寸图片幻灯片

表 1 176例病例临床资料基本情况

Table 1. Basic information on clinical data of 176 cases

变量	数量	构成比(%)
性别
女	41	23.3
男	135	76.7
年龄(岁)
≤60	86	48.9
＞60	90	51.1
肿瘤部位
上中段	113	64.2
下段	63	35.8
肿瘤长度(cm)
≤3	74	42.0
＞3	102	58.0
肿瘤分期
Ⅰ~Ⅱ	90	51.1
Ⅲ~Ⅳ	86	48.9
术后是否化疗
否	100	56.8
是	76	43.2
CA19-9^a	2.03	±0.81
NSEa	1.09	±0.49
1年生存率^b	OS：85.6%(95% CI：0.801~0.911)	DFS：83.8%(95% CI：0.781~0.895)
3年生存率^b	OS：55.4%(95% CI：0.454~0.654)	DFS：53.4%(95% CI：0.436~0.632)
注：^a CA19-9和NSE两组数据均经过自然对数转换；^b OS：总生存概率，DFS：无病生存概率。

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表 2 CA19-9和NSE与患者的一般临床特征的关系

Table 2. Correlation of CA19-9, NSE with the clinical characteristics of patients

	CA19-9(U/ml)			NSE(ng/ml)			CA19-9和NSE联合检测
	低表达组(n=94)	高表达组(n=82)	P值	低表达组(n=103)	高表达组(n=73)	P值	低表达组(n=60)	高表达组(n=116)	P值
性别			0.164			0.468			0.457
女	18	23		26	15		12	29
男	76	59		77	58		48	87
年龄(岁)			0.354			0.920			0.828
≤60	49	37		50	36		30	56
＞60	45	45		53	37		30	60
肿瘤部位			0.838			0.061			0.624
上中段	61	52		72	41		40	73
下段	33	30		31	32		20	43
肿瘤长度(cm)			0.091			0.252			0.473
≤3	34	40		47	27		23	51
＞3	60	42		56	46		37	65
肿瘤分期			0.778			0.308			0.461
Ⅰ-Ⅱ	49	41		56	34		33	57
Ⅲ-Ⅳ	45	41		47	39		27	59
术后是否放化疗			0.298			0.883			0.189
否	50	50		59	41		30	70
是	44	32		44	32		30	46

下载: 导出CSV

表 3 食管鳞癌患者Cox多因素回归分析

Table 3. Cox multivariate regression analyses of ESCC patients

变量	总生存		无病生存
变量	HR(95%CI)	P值	HR(95%CI)	P值
性别
女	1.000		1.000
男	0.973(0.493~1.922)	0.938	1.128(0.577~2.203)	0.725
年龄(岁)
≤60	1.000		1.000
＞60	0.959(0.536~1.714)	0.887	1.195(0.691~2.065)	0.524
肿瘤部位
上中段	1.000		1.000
下段	0.950(0.511~1.766)	0.870	1.030(0.578~1.835)	0.919
肿瘤长度(cm)
≤3	1.000		1.000
＞3	1.873(0.970~3.617)	0.062	1.720(0.925~3.195)	0.086
肿瘤分期
Ⅰ~Ⅱ	1.000		1.000
Ⅲ~Ⅳ	2.143(1.175~3.910)	0.013	2.269(1.273~4.046)	0.005
术后是否放化疗
否	1.000		1.000
是	0.907(0.505~1.628)	0.743	0.948(0.544~1.651)	0.849
CA19-9和NSE联合检测
低表达组	1.000		1.000
高表达组	2.310(1.208~4.418)	0.011	2.354(1.265~4.381)	0.007

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