目的探讨结直肠癌组织癌胚抗原相关黏附因子19（CEACAM19）的表达及其对结直肠癌预后评估的价值。
方法入选2015年7月至2018年7月北京怀柔医院结直肠癌患者98例，采用免疫组织化学法检测癌组织和癌旁组织（距肿瘤切缘>2 cm）CEACAM19蛋白表达水平，分析CEACAM19表达与临床病理参数的关系，单因素和多因素Cox回归分析影响患者预后的因素。Kaplan-Meier法绘制生存曲线。
结果癌组织CEACAM19高表达率明显高于癌旁组织[69.4%（68/98）比16.3%（16/98）]，差异有统计学意义（ χ 2 = 45.060， P<0.01）。癌组织CEACAM19表达与TNM分期有关（ P<0.05），与年龄、性别、肿瘤直径、分化程度、肿瘤位置、淋巴结分期、侵袭深度无关（ P>0.05）。单因素Cox回归分析结果显示，淋巴结分期、TNM分期和CEACAM19表达是影响结直肠癌患者总体生存的危险因素（ P<0.05或<0.01），TNM分期和CEACAM19表达是影响结直肠癌患者无病生存的危险因素（ P<0.01）。多因素Cox回归分析结果显示，TNM分期增加和CEACAM19高表达是影响结直肠癌患者总体生存（ HR = 2.628和0.199，95% CI 1.147~6.021和0.045~0.868， P = 0.022和0.032）和无病生存（ HR = 2.009和0.303，95% CI 0.965~4.185和0.101~0.911， P = 0.048和0.034）不良预后的独立危险因素。生存曲线分析结果显示，CEACAM19低表达结直肠癌患者中位总体生存时间和无病生存时间明显长于CEACAM19高表达结直肠癌患者（47.9个月比27.8月和43.2个月比26.3个月， P<0.01）。TNM分期Ⅰ~Ⅱ期结直肠患者中位总体生存时间和无病生存时间明显长于TNM分期Ⅲ期结直肠癌患者（43.9个月比24.2个月和39.3个月比23.7个月， P<0.01）。
结论结直肠癌患者癌组织CEACAM19呈高表达，CEACAM19可以作为评估结直肠癌患者预后的指标。
ObjectiveTo investigate the expression of carcinoembryonic antigen-related cell adhesion molecule 19 (CEACAM19) in colorectal cancer tissues, and evaluate the clinical pathological characters and prognostic significance.
MethodsNinety-eight patients with colorectal cancer in Beijing Huairou Hospital from July 2015 to July 2018 were selected. The expression level of CEACAM19 protein in primary colorectal cancer and corresponding non-tumor tissues (>2 cm) was detected by immunohistochemistry. The correlation between clinical pathological characters and CEACAM19 expression level was analyzed. The prognostic influencing factors were analyze by univariate and multivariate Cox regression methods. Survival curve was drawn by Kaplan-Meier method.
ResultsThe high expression rate of CEACAM19 in colorectal cancer tissues was significantly higher than that in adjacent non-tumor tissues: 69.4% (68/98) vs. 16.3% (16/98), and there was statistical difference ( χ 2 = 45.060; P<0.01). Expression of CEACAM19 in colorectal cancer tissues was significantly associated with TNM stage ( P<0.05), and was not associated with age, gender, tumor diameter, histological differentiation, tumor location, lymph node stage and invasion depth ( P>0.05). Univariate Cox regression analysis result showed that lymph node stage, TNM stage and CEACAM19 expression were influencing factors of overall survival in patients with colorectal cancer ( P<0.05 or <0.01), and the TNM stage and CEACAM19 expression were influencing factors of disease-free survival in patients with colorectal cancer ( P<0.01). Multivariate Cox regression analysis result showed that TNM stage increased and CEACAM19 high expression were independent risk factors of overall survival ( HR = 2.628 and 0.199, 95% CI 1.147 to 6.021 and 0.045 to 0.868, P = 0.022 and 0.032) and disease-free survival ( HR = 2.009 and 0.303, 95% CI 0.965 to 4.185 and 0.101 to 0.911, P = 0.048 and 0.034) in patients with colorectal cancer. Survival curve analysis result showed that the median overall survival and disease-free survival in CEACAM19 low expression patients were significantly longer than CEACAM19 high expression patients (47.9 months vs. 27.8 months and 43.2 months vs. 26.3 months, P<0.01); the median overall survival and disease-free survival in TNM Ⅰ to Ⅱ stage were significantly longer than TNM Ⅲ stage patients (43.9 months vs. 24.2 months and 39.3 months vs. 23.7 months, P<0.01).
ConclusionsThe CEACAM19 in colorectal cancer tissues is high expression, and the CEACAM19 expression level can be used as biomarker for prediction the prognosis of colorectal cancer.
随冬侠,姜庆龙,曲冰洁,等. 结直肠癌组织癌胚抗原相关黏附因子19表达及其对不良预后的评估价值[J]. 中国医师进修杂志,2020,43(1)：70-75.
DOI:10.3760/cma.j.issn.1673-4904.2020.01.017版权归中华医学会所有。
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