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目的 探讨联合应用癌胚抗原和糖类抗原19-9在提高胆囊癌患者预后判断中的临床意义.方法 回顾性分析第二军医大学东方肝胆外科医院2003年1月-2013年12月收治的390例胆囊癌手术患者的病例资料,探索术前联合应用癌胚抗原和糖类抗原19-9在预后判断中的临床价值.采用电话或门诊随访的方式,了解术后生存情况.连续变量以中位数(平均数)表示,分类变量以例数(n)表示.连续变量采用Mann-Whitney U检验.分类变量采用x2检验或Fisher确切概率法.Kaplan-Meier法绘制生存曲线,单因素分析采用Log-rank检验,多因素采用COX回归模型.结果 390例患者中327例有完全数据,中位随访时间为49(1 ～ 123)个月.癌胚抗原和糖类抗原19-9均能够预测胆囊癌预后,两项肿瘤标志物直线回归方程式得出的衍生联合变量特异度(0.9365)比单独的糖类抗原19-9 (0.7619)或癌胚抗原特异度(0.7937)更高.术前血检癌胚抗原和糖类抗原19-9双阴性组预后最好,中位生存期27.06个月,R0根治率较高(86.1％);而癌胚抗原和糖类抗原19-9双阳性组预后最差,中位生存期6.17个月,R0根治率较低(45.1％).结论 联合应用癌胚抗原和糖类抗原19-9可以提高胆囊癌患者的预后判断准确性,且临床实用.

Objective To investigate the clinical significance of joint application of carcinoembryionic and carbohydrate antigen 19-9 for improving the prognosis of patients with gallbladder cancer.Methods A retrospective analysis of clinical-pathological features and prognosis were conducted including 390 patients with gallbladder cancer,who were treated from January 2003 to December 2013 at Eastern Hepatobiliary Surgery Hospital of Second Military Medical University.The clinical value of joint application of careinoembryionic and carbohydrate antigen 19-9 in prognosis was explored.The survival of patients was followed up by telephone or outpatient.Continuous variables were indicated as median (average) and categorical variables were expressed as number(n).Mann-Whitney U test was applied for continuous variables.Categorical variables were compared by the Chi-square test or Fisher probability method.The survival curve was drawn by the Kaplan-Meier method.The univariate analysis and multivariate analysis of prognosis were respectively done using the Log-rank test and COX regression model.Results Of the 390 patients,327 had complete data.The median (range) follow-up time was 49 (1-123) months.Both carcinoembryionic and carbohydrate antigen 19-9 could be used to predict prognosis of gallbladder cancer.A linear combination of carcinoembryionic and carbohydrate antigen 19-9 was significantly better(0.9365) than carbohydrate antigen 19-9 (0.7619) as well as carcinoembryionic (0.7937) alone in term of specificity.Preoperative blood test carcinoembryionic and carbohydrate antigen 19-9 nature showed double-negative group had the best prognosis,with a median survival of 27.06 months,R0 radical rate was 86.1％.Doublepositive group had the worst prognosis,with a median survival of 6.17 months,R0 radical rate was 45.1％.Conclusions Combinations of pretherapeutic tumor makers carcinoembryionic and carbohydrate antigen 19-9 can improve the accuracy of predicting prognostic in patients with gallbladder cancer,and the clinical application is practical.