联合检测肿瘤标志物与炎症指标对结直肠癌的诊断价值*

Diagnostic value of combined detection of tumor markers and inflammatory markers in colorectal cancer*

摘要:

目的 探讨癌胚抗原（CEA）、糖类抗原19-9（CA19-9）、中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）等指标在结直肠癌诊断及预后中的价值。方法 收集2016年1月—2018年11月 广州中医药大学第一附属医院行结直肠癌手术治疗的158例患者的临床资料，以及从癌症基因组图谱数据库（TCGA）匹配出的316例结直肠癌患者的临床资料。分析不同临床病理特征与患者术前CEA、CA19-9的假阴性率及高低不同分组的NLR、PLR值的关系。根据分析结果确定联合检测指标并探讨联合检测对肿瘤远处脏器转移的预测作用。结果 在结直肠癌的诊断中，单用肿瘤标志物时假阴性率较高，且CA19-9假阴性率（72.78%）高于CEA假阴性率（49.58%）；随着肿瘤进展，肿瘤浸润较深、存在淋巴结转移、远处转移及分期较晚患者CEA假阳性率降低（P?<0.05）；CA19-9及PLR的升高提示结直肠癌患者存在远处脏器转移可能，且女性患者与高PLR值相关；CEA与NLR联合检测可能具有较好的预测结直肠癌远处脏器转移的作用（AUC=0.881，P?= 0.000）。结论 联合检测肿瘤标志物及炎症指标在提高结直肠癌诊断率、预测结直肠癌根治术后患者TNM分期及指导术后患者复查频率上具有一定的价值。

Abstract:

Objective To evaluate the diagnostic and prognostic value of a set of laboratory markers in colorectal cancer, including carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). Methods The clinical data from the First Affiliated Hospital of Guangzhou University of Chinese Medicine included 158 patients undergone surgical treatment from January 2016 to November 2018 and 316 patients from TCGA database were retrospectively analyzed. The relationship of clinicopathological features with the false negative rate of preoperative CEA and CA19-9, the NLR values and PLR values were analyzed. Combined detection indicators were determined according to analysis results, and the predictive effect of combined detection on distant metastasis of tumors was analyzed. Results In the diagnostic rate of colorectal cancer, the false negative rate was higher when tumor markers were used alone, and the false negative rate of CA19-9 (72.78%) was higher than the false negative rate of CEA (49.58%); the values of CEA and NLR were higher in patients with late stage, deeper tumor infiltration and lymph node or distant organ metastasis (P?