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目的 :探讨术前血清糖链抗原19-9(CA19-9)阳性和(或)甲胎蛋白(AFP)阳性的胃癌患者临床病理特征,及两者联合分析与胃癌的临床病理之间的联系。方法:回顾性分析南京医科大学第一附属医院900例术前检测血清CA19-9和AFP水平的胃癌患者临床病理资料。结果:与CA19-9阴性者相比,CA19-9阳性患者T分期更晚(T4期,94.2%vs.65.5%),临床分期更晚(Ⅲ+Ⅳ期,89.2%vs.61.5%),淋巴结转移率更高(80%vs.61.3%),脉管和神经侵犯比例更高(32.5%vs.23.3%;42.5%vs.27.1%),差异有统计学意义(P<0.05);与AFP阴性者相比,AFP阳性患者临床分期更晚(Ⅲ+Ⅳ期,88.9%vs.60.6%),淋巴结转移率更高(81.5%vs.59.1%),更容易发生神经侵犯(44.4%vs.27.0%),差异有统计学意义(P<0.05)。与CA19-9和AFP均阴性的患者相比,一种或两种肿瘤指标阳性的患者T分期更晚,临床分期更晚,淋巴结转移率更高,更容易出现脉管和神经侵犯(P<0.05)。二元Logistic回归多变量分析显示CA19-9阳性是影响胃癌侵犯深度的独立危险因素;与CA19-9(-)-AFP(-)比较,CA19-9(+)-AFP(+)是影响胃癌脉管浸润的独立危险因素,CA19-9(+)-AFP(-)是影响胃癌侵犯深度的独立危险因素(P<0.05)。结论 :术前血清CA19-9和AFP水平与胃癌临床病理密切相关,术前检测其水平有助于为胃癌患者临床病理特征提供信息。
OBJECTIVE: To investigate the clinicopathological features of preoperative serum glyco antigen 19-9 (CA19-9) positive and / or AFP positive gastric cancer, and the relationship between the combination analysis and the clinicopathological features of gastric cancer . Methods: The clinicopathological data of 900 gastric cancer patients with preoperative serum CA19-9 and AFP levels were retrospectively analyzed. Results: Compared with CA19-9 negative patients, T stage of CA19-9 positive patients was later (T4 stage, 94.2% vs 65.5%), clinical stage was later (stage Ⅲ + Ⅳ, 89.2% vs.61.5%), The rates of lymph node metastasis were higher (80% vs.61.3%), vascular and nerve invasion were higher (32.5% vs.23.3% and 42.5% vs.27.1%, respectively), with statistical significance (P <0.05) Patients with AFP-positive had more advanced clinical stages (stage Ⅲ + Ⅳ, 88.9% vs.60.6%), higher lymph node metastasis (81.5% vs.59.1%) and more aggressive neurological involvement (44.4% vs .27.0%), the difference was statistically significant (P <0.05). Patients with positive tumor markers of one or both tumors had later T staging, later clinical staging, higher rates of lymph node metastasis, and greater vulnerability to vascular and neurological involvement than those with negative CA19-9 and AFP (P < 0.05). Bivariate logistic regression analysis showed that positive CA19-9 was an independent risk factor for gastric cancer invasion. Compared with CA19-9 (-) - AFP (-), CA19-9 (+) - AFP CA19-9 (+) - AFP (-), an independent risk factor for vascular invasion, was an independent risk factor for gastric cancer invasion (P <0.05). Conclusion: The preoperative serum levels of CA19-9 and AFP are closely related to the clinicopathologic features of gastric cancer. Preoperative detection of the levels of CA19-9 and AFP may be useful for providing information on the clinicopathological features of gastric cancer.