Clinical Relevance of Cabohydrate Antigen 19-9 Level after Chemoradiotherapy in Rectal Cancer Patients with Normal Carcinoembryonic Antigen Level

以CA 19-9值來評估，癌胚抗原（CEA）值正常的直腸癌病患在接受術前放射線化療（CRT）後的預後

黃志生(Chih-Sheng Huang) ； 林春吉(Chun-Chi Lin) ； 藍苑慈(Yuan-Tzu Lan) ； 楊純豪(Shung-Haur Yang) ； 王煥昇(Huann-Sheng Wang) ； 姜正愷(Jeng-Kai Jiang) ； 陳維熊(Wei-Shone Chen) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin) ； 張世慶(Shin-Ching Chang)

《中華民國大腸直腸外科醫學會雜誌》 25卷3期 (2014/09) Pp. 106-114

https://doi.org/10.6312/SCRSTW.2014.25(3).10322

摘要

目的　癌胚抗原（CEA）是最廣泛使用的大腸直腸癌腫瘤指數。然而，對於CEA值正常的直腸癌病患，目前並沒有一個好的腫瘤標記來評估預後或者是追蹤病情。我們這個研究目的在探討直腸癌患者在接受術前放射線化療（CRT）後，其CA19-9值是否可以拿來作為病患的預後因子。方法　自2000年1月至2010年12月，共有474名直腸癌患者在台北榮總大腸直腸外科接受完整的術前CRT合併手術治療。部分患者因為各種因素被排除，其中包含第四期患者（n = 114），腫瘤位於直腸上段（n = 5），經肛門切除（n = 7），CEA ＞ 5（n = 108），缺乏完整CA19-9數據（N = 105）。最後剩下135名患者進入研究。所有患者進行了完整的術前評估以及術後的追蹤，本實驗主要是要做病患分組間的生存分析以及其他臨床病理檢查結果的比較。結果　本次研究的結果顯示出，post-CRT 19-9以及ypN這兩個變項對於直腸癌病患的5年無疾病存活期（disease free survival）為獨立的預後因子。我們的研究另外發現post-CRT 19-9的上升也和腫瘤的肺部轉移有關連性。結論　對於post-CRT 19-9上升的直腸癌病患，我們應該後續追蹤的部分得更加注意有無復發之情形，特別是肺部的部分。

關鍵字

直腸癌 ； 手術前放化療

並列摘要

Purpose. This study aimed to investigate the role of carbohydrate antigen 19-9 (CA19-9) in rectal cancer patients with normal carcinoembryonic antigen (CEA). Patients and Methods. From Jan 2001 to Dec 2010, 135 Patients who underwent preoperative chemoradiotherapy (CRT) followed by radical surgical resection were retrospectively enrolled from a prospectively constructed database. Characteristics of patients according to pre-CRT andpost-CRT CA19-9 concentrations were analyzed. Results. Patients with high post-CRT CA19-9 (≥ 37.0 u/ml) level were likely to have higher lymph node metastasis rate and tumor recurrence rate than those with normal post-CRT CA19-9 (＜ 37.0 ng/ml) level. Univariate and multivariate analysis showed that post-CRT CA19-9 level (HR = 8.474, 95% CI = 1.006~71.403) and ypN stage (HR = 2.422, 95% CI = 1.098~5.346) were independent prognostic factors for disease free survival rate.We also found that patients with high levels of post-CRT CA19-9 had a higher risk of lung metastasis (50.0% vs. 14.4%, p = 0.013). Conclusions. Post-CRT CA19-9 level might be an independent prognostic factor for disease-free survival in rectal cancer patients with normal (＜ 5 ng/ml) pre-CRT CEA treated with preoperative CRT and radical surgery. An aggressive surveillance protocol for lung metastasis should be used for those patients with high post-CRT CA19-9 levels.

並列關鍵字

Rectal cancer ； Pre-opera Tive Chemoradiotherapy ； CA 19-9

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