Correlation Between Preoperative Detection Of Circulating Tumor Cells Combined With Serum CEA,CA19-9 And CA125 And Lymph Node Metastasis Of Colorectal Cancer

Objective: To investigate the application value of preoperative circulating tumor cells combined with serum CEA,serum CA19-9 and serum CA125 levels in the clinicopathologic staging of colorectal cancer,and to construct a clinical prediction model to evaluate the predictive value of single index and comprehensive index detection for lymph node metastasis of colorectal cancer.Methods: Clinical data of patients with colorectal cancer who underwent radical resection of colorectal cancer and had complete preoperative blood markers and postoperative pathological reports were collected from the Second Affiliated Hospital of Nanchang University from September 2020 to February 2023.They were divided into colorectal cancer with lymph node metastasis group and colorectal cancer without lymph node metastasis group,including 86 cases of colorectal cancer with lymph node metastasis group and 117 cases of colorectal cancer without lymph node metastasis group.Preoperative circulating tumor cell(CTCS),serum CEA,serum CA19-9,serum CA125 levels and other relevant pathological factors were compared and analyzed,and then the threshold of various indicators of colorectal cancer with lymph node metastasis was determined by receiver operating characteristic(ROC)curve.The value of single and combined indicators in the diagnosis of lymph node metastasis of colorectal cancer was evaluated by assigning scores and drawing Nomo plots of logistic regression models.Results: A total of 203 patients with colorectal cancer treated in our hospital with complete preoperative blood markers and postoperative pathological reports were included in this study,including 86 patients with colorectal cancer with lymph node metastasis and 117 patients with colorectal cancer without lymph node metastasis.There were 20 cases of stage Ⅰ,97 cases of stage Ⅱ and 86 cases of stage Ⅲ.Lymph node metastasis of colorectal cancer was significantly correlated with vascular invasion,nerve invasion,depth of invasion,clinicopathological stage,circulating tumor cell level,serum CEA,serum CA19-9 and CA125 levels(P < 0.05).There were no significant differences in age,BMI,gender,tumor site or tumor size(P >0.05).For different TNM stages,serum CEA and serum CA125 increased with the increase of pathological stage.According to ROC curve assessment,the thresholds of CTC,serum CEA,serum CA19-9 and serum CA125 levels in CRC group with lymph node metastasis were 3 /3.2ml,2.81 ng /ml,19.3 U/ml and 17.65 U/ml,respectively.The sensitivity of CTC,serum CEA,serum CA19-9 and serum CA125 was 60.50%,58.10%,53.50% and 32.60%,and the specificity was 55.60%,64.1%,74.40% and89.70%.The sensitivity and specificity of combined detection were 64.10% and71.80% respectively.Area under the curve(AUC)for single and combined tests of CTC,serum CEA,serum CA19-9 and serum CA125 were 0.595,0.615,0.628,0.611 and 0.705.The area under the curve of the combined test was significantly larger than that of the single test,and the combined test had higher efficacy in evaluating lymph node metastasis of colorectal cancer.Conclusions: Preoperative CTC,serum CEA,CA19-9 and CA125 levels are closely associated with lymph node metastasis of colorectal cancer.Combined detection is more effective than separate detection of each marker in preoperative diagnosis of colorectal cancer.The sensitivity,specificity and accuracy of metastasis were improved.At the same time,it has a certain ability to evaluate whether colorectal cancer enters stage Ⅲ or Ⅳ.