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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
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李秋静,熊天琴,杨凤娟.术前血浆纤维蛋白原联合术后血清癌胚抗原对Ⅱ期结肠癌预后评估的临床价值[J].中华老年多器官疾病杂志,2018,17(9):656~661
术前血浆纤维蛋白原联合术后血清癌胚抗原对Ⅱ期结肠癌预后评估的临床价值
Prognostic value of preoperative fibrinogen and postoperative carcinoembryonic antigen in the patients with stage Ⅱ colon cancer
投稿时间:2018-04-22  修订日期:2018-07-03
DOI:10.11915/j.issn.1671-5403.2018.09.151
中文关键词:  纤维蛋白原;癌胚抗原;Ⅱ期结肠癌;联合;预后;临床价值
英文关键词:fibrinogen; carcinoembryonic antigen; stage Ⅱ colon cancer; combined; prognosis; clinical value
基金项目:
作者单位E-mail
李秋静 大理白族自治州人民医院消化科,大理 671000  
熊天琴 大理白族自治州人民医院消化科,大理 671000 3245931699@qq.com 
杨凤娟 大理白族自治州人民医院消化科,大理 671000  
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中文摘要:
      目的 探讨术前血浆纤维蛋白原(FIB)联合术后血清癌胚抗原(CEA)对Ⅱ期结肠癌患者预后的预测作用,为临床诊疗提供参考。方法 选取2010年3月至2013年3月在大理白族自治州人民医院消化科就诊并接受根治术治疗的Ⅱ期结肠癌患者129例作为研究对象,进行为期5年的随访,依据患者是否出现终点事件分为2组:预后良好组和预后不良组。采用SPSS 19.0 软件进行统计分析。采用Kaplan-Meier法对所有患者进行生存分析并绘制生存曲线。对可能影响生存时间的因素进行Cox回归分析。结果 Kaplan-Meier生存曲线显示,预后不良率为26.27%(31/118),且预后不良的人数随着时间的延长不断增多,其中随访第48个月增长较明显。多因素Cox回归分析提示腺癌(RR=2.79,95%CI 1.889~4.121;P=0.028),黏液癌(RR=2.81,95%CI 1.948~4.054;P=0.041),未分化癌(RR=2.83,95%CI 2.016~3.972;P=0.029),左半结肠癌(RR=2.72,95%CI 1.476~5.014;P=0.024),右半结肠癌(RR=2.71,95%CI 1.514~4.850;P=0.035)和术前FIB含量增高(RR=2.49,95%CI 1.499~4.137;P=0.033)以及术后CEA水平增高(RR=2.62,95%CI 1.659~4.137;P=0.026)均能影响患者预后。术前FIB的受试者工作特征曲线下面积(AUC)为0.581(95%CI 0.459~0.694),最佳截断点为7.27,灵敏度和特异度分别为68.8%和65.4%;术后CEA的AUC为0.773(95%CI 0.712~0.893),最佳截断点为5.78,灵敏度和特异度分别为61.3%和78.9%。两者联合诊断的AUC为0.812,灵敏度和特异度分别为74.1%和83.2%。结论 术前FIB和术后CEA水平为影响Ⅱ期结肠癌患者预后的危险因素,两者联合能提高预测的灵敏度和特异度,具有潜在推广应用价值。
英文摘要:
      Objective To investigate the prognostic value of preoperative fibrinogen (FIB) combined with postoperative carcino-embryonic antigen (CEA) in the patients with stage Ⅱ colon cancer in view of providing reference for clinical diagnosis and treatment. Methods A total of 129 patients with stage Ⅱ colon cancer were enrolled in this study, who were treated in the Department of Gastroenterology of Dali Bai Autonomous Prefecture People′s Hospital from March 2010 to March 2013. They were followed up for 5 years and were divided into good prognosis group and poor prognosis group, depending on whether the patient had an endpoint. SPSS statistics 19.0 was used for statistical analysis and Kaplan-Meier for survival analysis on all patients with survival curves being plotted. Cox regression analysis was performed for the factors that may affect survival time. Results The Kaplan-Meier survival curves showed a poor prognosis rate of 26.27%(31/118), and the number of patients with poor prognosis increased with time and more obviously at month 48. Multivariate Cox regression analysis predicted adenocarcinoma (RR=2.79,5%CI 1.889-4.121; P=0.028), mucinous carcinoma (RR=2.81, 95%CI 1.948-4.054; P=0.041), undifferentiated cancer (RR=2.83,5%CI 2.016-3.972; P=0.029), left colon cancer (RR=2.72,5%CI 1.476-5.014; P=0.024), right colon cancer (RR=2.71,5%CI 1.514-4.850; P=0.035), increased preoperative FIB (RR=2.49,5%CI 1.499-4.137; P=0.033), and increased postoperative CEA (RR=2.62,5%CI 1.659-4.137; P=0.026) all affected the prognosis. The preoperative FIB had an area under the receiver operating characteristic curve (AUC) of 0.581(95%CI 0.459-0.694), with an optimal cut-off point of 7.27, a sensitivity of 68.8% and a specificity of 65.4%. The AUC for postoperative CEA measured 0.773 [95%CI (0.712-0.893)] with an optimal cut-off point of 5.78, a sensitivity of 61.3% and a specificity of 78.9%. The preoperative FIB combined with postoperative CEA had an AUC of 0.812, with a sensitivity of 74.1% and a specificity of 83.2%. Conclusion Preoperative FIB and postoperative CEA are risk factors for the prognosis in the patients with stage Ⅱ colon cancer, and their combination can enhance the sensitivity and specificity of the prediction, suggesting potential clinical value.
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