Value of serum carbohydrate antigen 19-9, endothelial cell specific molecule 1 and C-reactive protein to albumin ratio in diagnosis and evaluating prognosis of colorectal cancer
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摘要:目的 分析血清糖类抗原19-9(CA19-9)、内皮细胞特异性分子1(ESM-1)及C反应蛋白与白蛋白比率(CRP/ALB)对结直肠癌的诊断价值及与临床病理特征和生存时间的关系。方法 选取86例结直肠癌患者为结直肠癌组, 50例同期结直肠良性病变患者为良性病变组, 50例体检健康者为对照组。检测3组血清CA19-9、ESM-1及CRP/ALB; 随访结直肠癌术后患者生存情况; 分析CA19-9、ESM-1、CRP/ALB对结直肠癌的诊断效能及与临床病理特征、生存时间的关系; 分析患者预后危险因素。结果 结直肠癌组血清CA19-9、ESM-1水平高于良性病变组、对照组, 差异有统计学意义(P < 0.05); 结直肠癌组CRP/ALB高于良性病变组，且良性病变组高于对照组，差异有统计学意义(P < 0.05)。CA19-9、ESM-1及CRP/ALB联合诊断结直肠癌的曲线下面积(AUC)为0.961, 敏感度为94.18%, 特异度为85.75%。CA19-9与淋巴结转移、远处转移相关(P < 0.05); ESM-1与TNM分期、远处转移相关(P < 0.05); CRP/ALB与肿瘤分化程度、TNM分期、淋巴结转移及远处转移相关(P < 0.05)。CA19-9、ESM-1、CRP/ALB高水平患者中位生存时间分别短于CA19-9、ESM-1、CRP/ALB低水平患者，差异有统计学意义(P < 0.05)。分化程度、TNM分期、远处转移、CA19-9、ESM-1、CRP/ALB为结直肠癌预后影响因素(P < 0.05)。结论 血清CA19-9、ESM-1及CRP/ALB联合检测对结直肠癌具有较高的诊断效能，且均与结直肠癌的发生发展密切相关，并影响患者预后。
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关键词:
- 结直肠癌 /
- 糖类抗原19-9 /
- 内皮细胞特异性分子1 /
- C反应蛋白与白蛋白比率
Abstract:Objective To analyze the diagnostic value of serum carbohydrate antigen 19-9 (CA19-9), endothelial cell specific molecule 1 (ESM-1) and ratio of C-reactive protein (CRP) to albumin (ALB) in colorectal cancer and their relationships with clinicopathological features and survival time.Methods Eighty-six patients with colorectal cancer were selected as colorectal cancer group, 50 patients with concurrent colorectal benign lesions were selected as benign lesion group, and 50 healthy subjects were selected as control group. Serum CA19-9, ESM-1 and CRP/ALB in three groups were detected; postoperative survival of colorectal cancer patients were followed up; diagnostic efficacy of CA19-9, ESM-1, CRP/ALB in colorectal cancer and their relationships with clinicopathological features and survival time were analyzed; prognostic risk factors were analyzed.Results Serum CA19-9 and ESM-1 levels in the colorectal cancer group were significantly higher than those in the benign lesion group and control group (P < 0.05); the CRP/ALB in the colorectal cancer group was significantly higher than that in the benign lesion group, and was significantly higher in the benign lesion group than that in the control group (P < 0.05). The area under curve (AUC) of combined diagnosis of CA19-9, ESM-1 and CRP/ALB for colorectal cancer was 0.961, the sensitivity was 94.18%, and the specificity was 85.75%. CA19-9 was correlated with lymph node metastasis and distant metastasis (P < 0.05); ESM-1 was correlated with TNM stage and distant metastasis (P < 0.05); CRP/ALB was correlated with tumor differentiation, TNM stage, lymph node metastasis and distant metastasis (P < 0.05). The median survival time of patients with high levels of CA19-9, ESM-1 and CRP/ALB was significantly shorter than that of patients with low levels (P < 0.05). The degree of differentiation, TNM stage, distant metastasis, CA19-9, ESM-1 and CRP/ALB were prognostic influencing factors for colorectal cancer (P < 0.05).Conclusion The joint detection of serum CA19-9, ESM-1 and CRP/ALB has a high diagnostic efficiency for colorectal cancer. They are all closely related to the occurrence and development of colorectal cancer, and affect the prognosis of patients. -
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表 1 3组基线资料比较(x±s)
组别 性别 年龄/岁 体质量指数/(kg/m2) 男 女 结直肠癌组(n=86) 48 38 61.14±7.32 23.55±2.44 良性病变组(n=50) 27 23 59.30±8.26 24.22±2.30 对照组(n=50) 26 24 59.40±7.71 23.89±2.40 
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表 2 3组CA19-9、ESM-1、CRP/ALB比较(x±s)
组别 n CA19-9/(U/mL) ESM-1/(pg/mL) CRP/ALB 结直肠癌组 86 26.53±4.12*# 30.27±4.30*# 0.11±0.02*# 良性病变组 50 21.94±4.18 25.21±3.51 0.08±0.01* 对照组 50 21.93±3.73 22.95±4.24 0.06±0.01 CA19-9: 糖类抗原19-9; ESM-1: 内皮细胞特异性分子1;
CRP/ALB: C反应蛋白与白蛋白比率。与对照组比较, *P < 0.05;
与良性病变组比较, #P < 0.05。
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表 3 CA19-9、ESM-1和CRP/ALB对结直肠癌的诊断价值
变量 AUC 标准误 P 渐进95%CI 截断值 上限 下限 CA19-9 0.784 0.041 < 0.001 0.703 0.865 24.03 ESM-1 0.826 0.035 < 0.001 0.758 0.894 28.49 CRP/ALB 0.923 0.022 < 0.001 0.879 0.966 0.10 三者联合 0.961 0.015 < 0.001 0.932 0.990 - CA19-9: 糖类抗原19-9; ESM-1: 内皮细胞特异性分子1; CRP/ALB: C反应蛋白与白蛋白比率。
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表 4 不同临床病理特征患者CA19-9、ESM-1、CRP/ALB比较[n(%)]
项目 n CA19-9 χ2 P ESM-1 χ2 P CRP/ALB χ2 P 高水平(n=41) 低水平(n=45) 高水平(n=41) 低水平(n=45) 高水平(n=36) 低水平(n=50) 肿瘤原发部位 0.896 0.344 0.259 0.611 0.170 0.680 结肠 36 15(36.59) 21(46.67) 16(39.02) 20(44.44) 16(44.44) 20(40.00) 直肠 50 26(63.41) 24(53.33) 25(60.98) 25(55.56) 20(55.56) 30(60.00) 肿瘤直径cm 1.766 0.184 3.103 0.078 2.692 0.101 < 5 cm 46 25(60.98) 21(46.67) 26(63.41) 20(44.44) 23(63.89) 23(46.00) ≥5 cm 40 16(39.02) 24(53.33) 15(36.59) 25(55.56) 13(36.11) 27(54.00) 肿瘤分化程度 0.032 0.857 0.032 0.857 8.653 0.003 高/中分化 76 36(87.80) 40(88.89) 37(90.24) 39(86.67) 27(75.00) 49(98.00)* 低/未分化 10 5(12.20) 5(11.11) 4(9.76) 6(13.33) 9(25.00) 1(2.00)* TNM分期 1.013 0.314 7.743 0.005 10.433 0.001 Ⅰ~Ⅱ 53 23(56.10) 30(66.67) 19(46.34) 34(75.56)* 15(41.67) 38(76.00)* Ⅲ~Ⅳ 33 18(43.90) 15(33.33) 22(53.66) 11(24.44)* 21(58.33) 12(24.00)* 淋巴结转移 10.995 0.001 3.688 0.055 20.861 0.010 有 27 20(48.78) 7(15.56)* 17(41.46) 10(22.22) 21(58.33) 6(12.00)* 无 59 21(51.22) 38(84.44)* 24(58.54) 35(77.78) 15(41.67) 44(88.00)* 远处转移 9.700 0.002 6.399 0.011 9.260 0.002 有 14 12(29.27) 2(4.44)* 11(26.83) 3(6.67)* 11(30.56) 3(6.00)* 无 72 29(70.73) 43(95.56)* 30(73.17) 42(93.33)* 25(69.44) 47(94.00)* 病理类型 0.529 0.971 2.132 0.344 5.101 0.078 腺癌 73 36(87.80) 37(82.22) 37(90.24) 36(80.00) 27(75.00) 46(92.00) 神经内分泌肿瘤 8 3(7.32) 5(11.11) 3(7.32) 5(11.11) 5(13.89) 3(6.00) 黏膜内癌 5 2(4.88) 3(6.67) 1(2.44) 4(8.89) 4(11.11) 1(2.00) CA19-9: 糖类抗原19-9; ESM-1: 内皮细胞特异性分子1; CRP/ALB: C反应蛋白与白蛋白比率。与高水平比较, *P < 0.05。
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表 5 CA19-9、ESM-1、CRP/ALB与病理特征的关系
病理特征 CA19-9 ESM-1 CRP/ALB 95%CI P 95%CI P 95%CI P 分化程度 0.658~1.237 0.613 0.705~1.328 0.547 1.409~3.391 0.001 TNM分期 0.798~1.365 0.536 1.780~3.704 < 0.001 1.613~2.612 < 0.001 淋巴结转移 1.529~2.419 < 0.001 0.605~1.178 0.492 1.869~2.820 < 0.001 远处转移 2.272~3.538 < 0.001 2.210~3.245 < 0.001 3.306~5.791 < 0.001 CA19-9: 糖类抗原19-9; ESM-1: 内皮细胞特异性分子1; CRP/ALB: C反应蛋白与白蛋白比率。
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表 6 患者预后COX回归分析
变量 β SE Wald OR 95%CI P 肿瘤直径 0.062 0.128 0.235 1.064 0.828~1.367 0.628 分化程度 1.087 0.106 105.159 2.965 2.409~3.650 < 0.001 TNM分期 1.248 0.123 102.948 3.483 2.737~4.433 < 0.001 淋巴结转移 0.047 0.119 0.156 1.048 0.830~1.323 0.693 远处转移 0.928 0.136 46.561 2.529 1.938~3.302 < 0.001 CA19-9 0.875 0.114 58.912 2.399 1.919~2.999 < 0.001 ESM-1 1.356 0.248 29.896 3.881 2.387~6.310 < 0.001 CRP/ALB 1.132 0.196 33.357 3.102 2.112~4.555 < 0.001 CA19-9: 糖类抗原19-9; ESM-1: 内皮细胞特异性分子1; CRP/ALB: C反应蛋白与白蛋白比率。
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