| Background:Colorectal cancer is one of the most common human malignant neoplasms,and its incidence has been ranked the highest,ranking the 3rd and 2nd place respectively in men and women in the world[1].It is estimated that 1,360,600 people worldwide were diagnosed with colorectal cancer in 2012 and 693,900 died of colorectal cancer.The incidence of colorectal cancer is on the rise in China.In 201 5,there were 376,300 new cases of colorectal cancer in our country and 191,000 patients died of colorectal cancer.At present,the mortality rate of male and female malignant tumors has risen 5,4[2].The incidence of colorectal cancer increased year by year,this phenomenon may be related to changes in lifestyle,diet and atmospheric environment,in addition,the popularity of the concept of healthy physical examination and imaging means to improve early detection of colorectal cancer,early diagnosis Fat play a significant role.As we all know,colorectal cancer onset occult,when the diagnosis has been accounted for the majority of late.The treatment of colorectal cancer with surgery,chemotherapy,radiotherapy,targeted therapy,for patients with advanced colorectal cancer,surgery combined with postoperative chemotherapy,radiotherapy and other comprehensive treatment is the main treatment options,but more patients with advanced bone Metastasis,lung metastasis,liver metastases,brain metastases,etc.,the general situation is poor,poor treatment tolerance,high mortality.For early and mid-term colorectal cancer,the patient is generally good,and the tumor confined to the local,can do a radical resection,postoperative adjuvant chemotherapy,the treatment effect is good,the mortality rate is low.Currently used in clinical testing for the detection of colorectal cancer many ways,fecal occult blood test and barium enema double contrast radiography low sensitivity,limited diagnostic value,colonoscopy is a good diagnosis of colorectal cancer However,the examination of some high-risk patients is limited due to the discomfort caused by the examination process or the contraindication of the examination.B ultrasound imaging low sensitivity,CT,MRI,PET-CT and other expensive examination,not suitable for general health examination.Serum tumor markers(TM)are convenient,rapid,noninvasive and well-tolerated in patients and are important for aiding diagnosis,guiding treatment,monitoring metastasis or recurrence,and prognosing prognosis of the disease due to the detection of small trauma and few contraindications use.However,screening for large populations is limited in their usefulness because of their lower sensitivity,so if an effective tumor marker is found and early lesions of colorectal cancer are found,the best time is spent on treatment,which is a reduction The mortality of patients with colorectal cancer is of great significance.In clinical practice,the accuracy of diagnosis can be improved by joint detection,which helps to improve the diagnosis and prognosis of clinical tumors.This study evaluated the value of combined detection of CEA,CA19-9 and CA72-4 in the prognosis of patients with stage I-III colorectal cancer so that clinicians could evaluate more accurately the treatment and prognosis of colorectal cancer.Research object:A total of 101 patients with stage I-III colorectal cancer undergoing surgery in Nanfang Hospital of Southern Medical University from January 2012 to December 2015 were selected,including 71 males and 30 females with an average age of(53 ± 11)year old.All the patients were examined preoperative and postoperative serum tumor markers CEA,CA19-9 and CA72-4.Inclusion criteria:1)histological diagnosis of colon or rectal cancer;2)complete resection of the primary tumor;3)identification of stage Ⅰ-Ⅲ patients as TNM staging by the American Joint Commission on Cancer(AJCC);4)Merged distant metastasis;5)sign the informed consent of pathological examination;6)pathological findings and postoperative follow-up information is complete.Exclusion criteria:1)histopathology can not be diagnosed as colon or rectal cancer;2)patients with unknown stage or stage Ⅳ;3)preoperative treatment(radiotherapy and chemotherapy,etc.);4)non-tumor causes of death;5);6)refused to sign the informed consent for pathological examination.Methods:1.Evaluation indicators:Colorectal cancer patients were followed up for 24 months,were observed in patients with preoperative and postoperative 1 month,3 months after surgery,6 months after surgery,12 months after surgery and postoperative 24-month changes in CEA,CA19-9 and CA72-4 values.Fasting blood samples were collected 4 ml,1 h centrifugal separation of serum.CA19-9 and CEA were determined by ACS-A80 chemiluminescence analyzer;CA72-4 was detected by using Delian’s semi-automatic enzyme-free analyzer.The kit was supplied by Bayer AG of Germany and Delton USA respectively.To analyze the relationship between the expression and the prognosis of patients with colorectal cancer.2.The positive standard of CEA was 0～5 ng/ml,positive for CEA was>5 ng/ml,positive for CA19-9 was 0-35 U/ml,positive for>35 U/ml,4 normal value of 0～6.9 U/ml,>6.9 U/ml is positive.3.Statistical analysis:The levels of serum CEA,CA19-9 and CA72-4 were expressed as mean ±standard deviation(x±s).The measurement data were analyzed by T test.The count data were analyzed by χ2 test.Survival analysis was performed by Kaplan-Meier Act,P<0.05 for the difference was statistically significant,the above tests are bilateral test.Results:1.Clinical characteristics of three serum TM levels positive and negative groups:The study enrolled 101 patients with colorectal cancer.Serum CEA positive group and negative group in age,gender,depth of invasion,TNM stage,lymph node metastasis,relapse within two years after surgery,Dukes staging were statistically significant(P<0.05),while in hypertension,diabetes,tumor site,Tumor size,pathological type,tumor differentiation degree had no statistical significance(P>0.05),Serum CA19-9 positive group and negative group had significant difference in tumor location,TNM stage,lymph node metastasis,relapse within two years after operation,Dukes stage(P<0.05),but not in age,sex,hypertension,diabetes,Tumor size,pathological type,tumor differentiation,depth of invasion were not statistically significant(P>0.05).Serum CA72-4 positive group and negative group in hypertension,TNM stage,lymph node metastasis,relapse within two years after operation,Dukes staging difference was statistically significant(P<0.05),but in age,gender,diabetes,tumor site,Tumor size,pathological type,tumor differentiation,depth of invasion were not statistically significant(P>0.05).2.Three indicators of single and combined detection of diagnostic performance evaluation:calculated by the upper limit of the reference range CEA,CA19-9 and CA72-4 single and three joint detection of colorectal cancer diagnosis of sensitivity,specificity,positive The predictive value and the negative predictive value showed that the sensitivity of the three kinds of TM alone was lower,and the sensitivity of the combined test was significantly higher than that of the single test,but the specificity was decreased.3.The postoperative CEA,CA19-9 and CA72-4 levels compared with the preoperative:The three kinds of TM levels preoperatively higher,but postoperative were significantly lower,postoperative and preoperative TM levels were statistically different(P<0.05).But with the increase of postoperative time,the TM level showed an increasing trend.4.The relationship between the three kinds of TM levels and the prognosis of postoperative survival:Of the 101 patients who were followed up for 2 years,33 patients had postoperative recurrence,and the tumor markers remained low at 2 years after operation without recurrence Tumor markers increased significantly in 33 patients with recurrent disease.The Kaplan-Meier survival curves and Log-rank test showed that the levels of tumor markers in CEA-positive group,CA 19-9-positive group and CA72-4-positive group were significantly correlated with postoperative recurrence of colorectal cancer(P<0.05).Further analysis of recurrent patients found that among the 33 relapsed patients,the recurrence rates were 6%(2/33),27%(9/33),24%(8/33),43%(14/33).The highest probability of recurrence was found at 12-24 months postoperatively,reaching 67%(22/33),indicating that stage I-III colorectal cancer Patients have a high risk of recurrence 12-24 months postoperatively,and are predominantly 18-24 months postoperatively,accounting for 43%(14/33)of the patients with postoperative recurrence.ConclusionThe joint test of CEA,CA19-9 and CA724 has an important significance in prognosis of colorectal cancer,which helps to predict the reintegration of patients with colorectal cancer for 2 years after surgery,which is of great significance for clinical guidance therapy. |
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