壶腹腺癌胰十二指肠切除术后预后相关因素分析

目的:探讨影响壶腹腺癌患者行胰十二指肠切除术预后相关因素。方法:回顾2007年1月—2014年12月期间接受胰十二指肠切除术治疗的壶腹腺癌患者的临床及病理资料,分析患者术后生存的影响因素。结果:全组患者术后1、3、5年生存率分别为87.5%、64.3%、54.5%。单因素分析显示,术前总胆红素、直接胆红素、CEA、CA19-9、CA242、肿瘤分化程度、肿瘤浸润深度、淋巴结转移、肿瘤分期、胰腺侵犯、神经侵犯、术后辅助治疗是影响壶腹腺癌患者术后生存的影响因素(均P0.05)。多因素分析显示,CEA、肿瘤浸润深度是影响壶腹腺癌患者术后生存的独立影响因素(均P0.05)。结论:壶腹腺癌患者行胰十二指肠切除术后的预后与多种因素相关,CEA、肿瘤浸润深度是评价壶腹腺癌患者预后最重要的指标。     

胰腺癌根治术后病人生存相关因素分析

目的探讨影响胰腺癌根治性切除病人术后生存的相关因素。方法回顾性分析2010年1月至2013年12月南京医科大学第一附属医院胰腺中心行根治性手术的275例胰腺癌病人的临床资料,包括临床病理资料和生存随访资料。结果随访18(9~36)个月,共216例(78.5%)病人死亡,总体中位生存时间为15.1个月(95%CI 11.7~18.4),1、3、5年存活率分别为63.2%、23.1%、11.8%。行术后化疗病人术后生存时间29.1个月(19.5~38.7),1、3、5年存活率分别为78.6%、43.6%、25.4%。Cox回归分析提示,术前CA19-9水平、肿瘤分化水平、肿瘤长径、阳性淋巴结比、镜下血管侵犯、术后化疗是胰腺癌病人术后生存的独立影响因素(P0.05)。进一步按手术方式进行分层分析,行胰十二指肠切除术病人术后生存独立影响因素包括术前CA19-9水平、肿瘤分化、肿瘤长径、血管侵犯、术后化疗(P0.05),胰体尾切除病人术后生存独立影响因素包括肿瘤分化、血管侵犯、阳性淋巴结比、术后化疗(P0.05)。结论术前高CA19-9水平、高阳性淋巴结比、肿瘤分化水平差以及有镜下血管侵犯的胰头癌和胰体尾癌病人预后更差。根治性手术基础上联合辅助化疗可显著延长胰腺癌病人存活时间,是改善胰腺癌预后的重要手段。     

CA19-9/GGT与胰头癌术后远期生存的相关性分析

本文回顾性分析2013年1月至2019年12月在首都医科大学附属北京朝阳医院肝胆外科因胰头癌行胰十二指肠切除术的154例患者的临床及随访资料。根据患者术前CA19-9/GGT与1年生存情况绘制ROC曲线,确定CA19-9/GGT的最佳cut-off值,并以此将患者分为低比值组和高比值组。单因素及多因素分析筛选出CA19...     

血清CA19-9、CA242、CEA及CA125在胰腺癌诊断和预后中的价值

目的探讨CA19-9、CA242、CEA和CA125四种肿瘤标志物单独检测或联合检测在胰腺癌诊断和预后中的价值。方法测定并分析我院2007年1月至2009年12月期间收治的63例胰腺癌患者、33例胆管癌和27例胰腺良性疾病患者血清中CA19-9、CA242、CEA和CA125水平,并对术后胰腺癌患者进行随访。结果胰腺癌患者血清中CA19-9、CA242、CEA和CA125水平明显高于胰腺良性疾病患者和胆管癌患者(P<0.05)。单项检测中血清CA19-9的敏感性最高,达79.4%(50/63),但其特异性(61.7%)低于CA242(83.3%)和CEA(80.0%)。联合检测CA19-9+CA242+CEA的特异性最高,达93.3%(56/60)。当肿瘤位于胰腺体/尾部时CA19-9水平显著高于其在胰腺头部或全胰腺时(P<0.05)。胰腺癌Ⅳ期患者的CA19-9和CA242水平显著高于Ⅰ或Ⅱ/Ⅲ期患者(P<0.05)。本组失访15例,48例获得随访,随访时间平均6个月(2~12个月)。胰腺癌患者术后0.5及3个月血清中CA242、CA19-9较术前明显降低(P<0.05)。结论单项检测CA19-9可以提高胰腺癌诊断的敏感性,联合检测CA19-9+CA242+CEA可以提高胰腺癌诊断的特异性,CA19-9和CA242对胰腺癌的治疗效果及预后判断更具有价值。     

胰腺腺癌行胰十二指肠切除后进行辅助性放疗化疗可以提高患者的生存率

在美国肿瘤死亡谱中，胰腺癌是第5大死因，总的5年生存率不足3％。目前，胰腺癌患者进行手术切除治疗是长期存活的唯一希望。但是肿瘤术后的局部和远处复发率却很高。有人提出，胰腺腺癌行胰腺切除术后进行辅助性放疗化疗可以显著提高患者中期、长期生存率。本实验前瞻性研究胰腺腺癌患者行胰十二指肠切除术后，进行辅助性放疗化疗和不接受术后辅助治疗的生存率的情况。病例与方法选择JohnHopkins医院从1991年10月到1995年9月期间共174例因胰头、胰颈及胰腺约突的导管腺癌行选择性胰十二指肠切除术的病例，不包括十二指肠肿瘤、壶腹部肿瘤…     

胰头占位性病变的诊断与治疗

目的 总结胰头占位性病变的诊断与治疗经验.方法 回顾性分析2011年1月至2014年4月中国医科大学附属第一医院收治的247例胰头占位性病变患者的临床资料.术前均行胰腺增强CT和(或)胰腺MRI等影像学检查.血清学检查包括AFP、CA19-9、CA125、CEA,对于怀疑自身免疫性胰腺炎的患者检查血清IgG4.临床诊断为胰头癌、胰头肿块、肿块型胰腺炎的患者行术中病理学检查.胰头癌根据肿瘤的分期及浸润程度选择胰十二指肠切除术、扩大的胰十二指肠切除术或胆肠吻合和(或)胃肠吻合术.肿块型慢性胰腺炎在患者及家属充分了解并同意的前提下选择行保留十二指肠的胰头切除术或胰十二指肠切除术.胰腺良性及低度恶性肿瘤应在肿瘤完整切除的基础上尽量保留肿瘤周围的组织和器官,行个体化治疗.结果 胰头实性占位性病变194例,其中胰头癌125例、胰头肿块45例、肿块型慢性胰腺炎9例、自身免疫性胰腺炎11例,胰岛素瘤4例;胰头囊性占位性病变53例,其中黏液性囊腺瘤12例、浆液性囊腺瘤8例、胰腺囊肿17例、实性假乳头状瘤12例、导管内乳头状黏液瘤4例.病理学检查确诊胰腺癌的71例患者术前肿瘤系列检查阳性率分别为:AFP为7.0％ (5/71)、CA19-9为94.4％ (67/71)、CA125为42.3％(30/71)、CEA为0.12例肿块型慢性胰腺炎肿瘤系列检查阳性率分别为:AFP为1/12、CA19-9为4/12、CA125为1/12、CEA为0.119例患者进行手术治疗获得病理学诊断,其中胰头癌71例、肿块型慢性胰腺炎7例、胰岛素瘤4例、胰腺结核1例,黏液性囊腺瘤8例、浆液性囊腺瘤4例、胰腺假性囊肿6例、巨大淋巴管瘤1例、淋巴上皮囊肿1例、实性假乳头状瘤12例、导管内乳头状黏液瘤4例.247例胰头占位性病变患者中,61例行胰十二指肠切除术,4例行保留十二指肠的胰头切除术,4例行胰头、胰颈部切除术,2例行钩突部分切除术,9例行肿瘤摘除术,38例行胆肠吻合和(或)胃肠吻合术,22例行ERCP+内支架治疗,18例行PTCD+内支架治疗,1例行剖腹探查,88例未行治疗.结论 胰头占位性病变的临床诊断及鉴别诊断主要依靠病史、临床表现、实验室检查及超声、CT、MRI检查.根据肿瘤性质、疾病种类个体化制订手术方案,对胰头良性及低度恶性的肿瘤应行个体化治疗,在肿瘤完整切除的基础上尽量保留肿瘤周围的组织和器官,术中病理学诊断有利于手术方案的选择.     

胰腺癌128例手术疗效的临床观察

目的探讨胰腺癌手术治疗的临床疗效及其预后。方法对1996年1月-2004年12月我院收治的128例胰腺癌病人的临床资料进行回顾性研究。按治疗方式分为胰十二指肠切除术组（28例）、姑息手术组（50例）和未手术组（50例）。结果全组根治性手术切除率为35．90％。胰十二指肠切除术组1、3、5年生存率分别为67．86％、14．29％、3．57％，显著高于其它两组（P〈0．01）；胰十二指肠切除术组生存率曲线显著高于其它两组（P〈0．01）；手术组生存质量显著高于未手术组（P〈0．05）。结论对胰腺癌施行根治性胰十二指肠切除术能显著提高治疗效果及改善预后，从而提高远期生存率并明显提高病人的生存质量。对不能行根治性切除的病人应争取行姑息性手术，亦可改善病人的生存质量。     

胰腺癌神经侵犯研究进展

胰腺癌是一种起源于胰腺导管上皮及腺泡的恶性肿瘤。目前,其手术切除率仅为10%～44%,术后1年腹膜后局部复发率高达约60%。肿瘤位于胰头部称为胰头癌(PHC),约占胰腺癌的90%,胰十二指肠切除术(PD)是治愈胰头癌的唯一方式,但其术后5年生存率仅为5%~6%。大多数患者局部复发的主要原因是胰头癌具有嗜神经性,癌细胞会沿着胰周神经束浸润生长。因此,胰周神经丛的手术清扫完全与否成为胰腺癌患者胰十二指肠切除术后长期生存的重要保证,本文对胰十二指肠切除术中如何标准有效地清扫胰后神经丛进行综述。     

全胰腺切除+脾切除术治疗胰腺癌

目的探讨全胰腺切除+脾切除术治疗胰腺癌的效果及安全性。方法回顾性分析青海大学附属医院肝胆胰外科收治的1例行全胰腺切除+脾切除治疗的全胰腺癌患者的术前临床资料、手术治疗过程及术后情况。结果结合患者术前病史、影像学及实验室检查结果考虑诊断为胰腺癌拟行经典的胰十二指肠切除术,术中发现全胰腺质地较硬且考虑脾动静脉受侵,多次送病检均提示胰腺切缘阳性,遂改行全胰腺切除+脾切除术。术后病理诊断符合高-中分化导管腺癌,患者病情平稳后长期给予胰酶制剂口服、胰岛素皮下注射治疗,无严重并发症发生,恢复良好,随访至今3个月未见复发。结论随着手术技术的提高及术后管理的加强,全胰腺切除可作为胰腺癌的一种治疗方式仍是安全、可行的。     

全胰切除术在原发性胰腺肿瘤治疗中的价值——一个重新被认识的少见术式

正目的本文探讨全胰切除术后患者围手术期并发症和长期生存预后。背景胰腺切除术是胰腺癌综合治疗中的重要方法之一,也是唯一可能治愈胰腺癌的方式。目前,胰十二指肠切除术和胰体尾部切除术已成为固定术式,其近期及远期效果得到临床证实。然而,有关全胰切除术在胰腺肿瘤治疗中的价值的研究较少。方法收集2001年10月至2012年9月期间德国海德堡大学医学院行全胰切除术的596患者资料,排除不符合纳入标准的152例,共纳入434例患者:63例术前发现肿瘤位于胰腺中段或胰腺多发性病灶;126例术中探查发现肿瘤巨大而更改手术方案;156例胰腺切缘术中冰冻提示肿瘤残留而行全胰切除术;40例患者行肝动脉、腹腔干、肠系膜上动脉切除或重建;4例因胰腺部分切除术     

CA19-9 on Postoperative Surveillance in Pancreatic Ductal Adenocarcinoma: Predicting Recurrence and Changing Prognosis over Time

Background

Serum carbohydrate antigen 19-9 (CA19-9) correlates with response to therapy and overall survival (OS) for patients with pancreatic ductal adenocarcinoma (PDAC). This study aimed to define the chronologic relationship between CA19-9 elevation and radiographic recurrence to develop a model that can predict the risk of recurrence (RFS) and prognosis during interval surveillance for patients with resected PDAC.

Methods

A retrospective review examined patients undergoing surgery for pancreatic adenocarcinoma from January 2010 to May 2016. Their CA19-9 levels were classified at diagnosis, after surgery, and at 6-month surveillance intervals. Recurrence was defined by radiographic evidence. The CA19-9 levels were correlated with RFS and OS at every time point using multivariate analysis.

Results

The study examined 525 patients. Five patterns of CA19-9 were identified: normal (“nonsecretors,” 18.5%), always elevated, and high at diagnosis but normal after resection involving three patterns with varied behavior during surveillance. These five patterns had implications for RFS and OS. When elevation of CA19-9, as assessed at 6-month intervals, was analyzed relative to detection of radiographic disease, CA19-9 had poor positive predictive value (average, 35%) but high negative predictive value (average, 92%) for radiographic recurrence. Conditional RFS showed that CA19-9 elevation did not equal radiographic recurrence but predicted subsequent RFS. Additionally, conditional OS showed that CA19-9 elevation alone was predictive at each time point.

Conclusion

This study showed that CA19-9 patterns beyond the post-resection period predict RFS and OS. High CA19-9 frequently is discordant with recurrence on imaging and may precede it by more than 6 months. At each surveillance interval, CA19-9 is predictive of prognosis, which may help in counseling patients and could be used to direct protocols of salvage chemotherapy.

     

���ٰ�����Ԥ�����ط�����AJCC��8��TNM�����������ۣ���143�����棩

??Prognostic factors for long-term survival in patients with pancreatic adenocarcinoma and evaluation of 8th AJCC staging??A report of 143 cases LI Ji-song??TIAN Xiao-dong??GAO Hong-qiao, et al. Department of General Surgery??Peking University First Hospital??Beijing 100034??China
Corresponding author??YANG Yin-mo??E-mail??yangyinmo@263.net
Abstract Objective To analyze clinicopathological factors influencing the prognosis of the patients with resectable pancreatic ductal adenocarcinoma (PDAC) and evaluate the 8th AJCC TNM staging. Methods A total of 143 cases of PDAC underwent resection in Department of General Surgery of Peking University First Hospital from January 2010 to December 2016. The clinical and survival data were analyzed retrospectively for prognostic factors. Results A total of 100 patients (69.9%) with pancreatic head carcinoma underwent pancreatoduodenectomy, while 43 patients (30.1%) with tumors located in the pancreatic body/tail underwent distal pancreatectomy or total pancreatectomy. Multivisceral resections were performed in 10 patients (7.0%). R0 margins were achieved in 55 patients (38.5%). The percentage of R1 and R2 resections were 58.7% and 2.8%, respectively. A total of 75 patients (52.4%) received adjuvant chemotherapy. The median overall survival (OS) time was 20 (95%CI 17.5-22.5) months and disease-free survival (DFS) time was 14 (95%CI 12.5-15.5) months. Univariate and multivariate analysis revealed that AJCC T staging, N staging, R2 resection margin status, low- or un-differentiated grade, vascular resection, neutrophil-to-lymphocyte ratio (NLR) ≥2, CA19-9≥400 U/mL and adjuvant chemotherapy were prognostic factors??P<0.05??. The 8th AJCC TNM staging was significantly associated with prognosis. Conclusion TNM staging system could predict prognosis accurately on the basis of adequate examined lymph nodes. R0/R1 resection and adjuvant chemotherapy could improve the survival of the patients significantly.     

胰腺癌术后预后因素分析及AJCC第8版TNM分期意义评价（附143例报告）

目的 探讨影响胰腺癌术后远期预后的危险因素,评价美国癌症联合委员会（AJCC）第8版TNM分期的临床价值。方法 回顾性分析2010年1月至2016年12月行手术切除的143例胰腺导管腺癌病人的临床病理及随访资料,通过Cox回归模型和Kaplan-Meier法分析预后相关危险因素。结果 胰头癌100例（69.9%）,胰体尾癌43例（30.1%）;行胰十二指肠切除术100例,胰体尾及脾切除术42例,全胰腺切除术1例,其中联合器官切除10例（7.0%）;R0切除55例（38.5%）,R1切除84例（58.7%）,R2切除4例（2.8%）;术后辅助治疗75例（52.4%）。病人术后中位总生存期（OS）为20（95%CI 17.5~22.5）个月,中位无病生存期（DFS）为14（95%CI 12.5~15.5）个月。单因素及多因素分析提示,AJCC T分期、N分期、手术切缘状态、肿瘤分化程度、联合血管切除与否、中性粒细胞/淋巴细胞比（NLR）≥2、CA19-9≥400 kU/L、辅助化疗是病人预后的独立影响因素（P<0.05）。AJCC第8版TNM分期对于预后具有良好的预测价值。结论 AJCC TNM分期在一定淋巴结清扫数目的基础上可准确预测病人预后,R0或R1切除及术后辅助治疗可显著改善病人预后。     

肿瘤标志物和Ki67在结直肠癌中的表达及预后因素分析

目的探讨术前血清肿瘤标志物与术后Ki67联合检测对结直肠癌病人预后评估的价值。方法收集2012年1月至2014年6月在武汉大学人民医院胃肠外科就诊的结直肠癌病人的临床病理资料和随访资料。癌胚抗原(CEA)>5μg/L定义为阳性,癌抗原(CA)19-9>35 kU/L定义为阳性。Ki67 LI大于其对应截断值定义为高表达(阳性)。绘制受试者工作特征(ROC)曲线寻找Ki67 LI的截断值[曲线下面积(AUC)最大时];Cox回归分析寻找影响结直肠癌病人预后的独立危险因素。结果研究共纳入311例结直肠癌病人,截至2019年6月1日,中位随访67个月(3~89个月),随访率94.2%,病死率32.5%。单因素生存分析提示,CEA阳性、CA19-9阳性,Ki67高表达与结直肠癌病人预后不良相关(均P<0.01)。联合血清肿瘤标志物和Ki67的生存分析结果提示,均阴性时病人预后最好,单阳性时次之,均阳性时最差(均P<0.01)。Cox回归结果提示:CEA[HR=6.461,95%CI(3.693,11.304),P<0.01]、CA19-9[HR=2.046,95%CI(1.214,3.449),P=0.007]、TNM[HR=2.104,95%CI(1.597,5.242),P=0.028]、CEA+Ki67[HR=9.992,95%CI(5.337,18.706),P<0.01]、CA19-9+Ki67[HR=5.345,95%CI(2.282,12.521),P<0.01]是影响预后的独立危险因素。结论联合检测术前血清肿瘤标志物和术后Ki67指标对评估结直肠癌病人预后具有重要价值。     

Carbohydrate antigen 19-9 as a novel prognostic biomarker in distal cholangiocarcinoma

BACKGROUNDDistal cholangiocarcinoma (DCC) presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis. Curative resection is currently the most appropriate therapy for patients with DCC because of the lack of effective adjuvant therapies. Therefore, it is important to accurately predict the prognosis for formulating a reasonable treatment plan and avoiding unnecessary surgical trauma.AIMTo minimize the interference of obstructive jaundice on carbohydrate antigen 19-9 (CA19-9) level by adapting CA19-9 to γ-glutamyltransferase (GGT) as an indicator, to determine the strong associations between CA19-9/GGT and postoperative neoplasm recurrence and long-term outcome of DCC.METHODSWe enrolled 186 patients who were diagnosed with DCC between January 2010 and December 2019 and performed radical excision with strict criteria as follows in our hospital. Receiver operating characteristic curves were drawn according to preoperative CA19-9/GGT and 1-year survival. Based on this, patients were divided into two groups (group 1, low-ratio, n = 81; group 2, high-ratio, n = 105). Afterwards, by the way of univariate and multivariate analysis, the risk factors influencing postoperative tumor recrudesce and long-term prognosis of patients with DCC were screened out.RESULTSOptimum cut-off value of CA19-9/GGT was 0.12. Patients in group 2 represented higher CA19-9 and lymphatic metastasis rate accompanied by lower GGT, when compared with group 1 (P < 0.05). The 1-, 3- and 5-year overall survival rates of patients in groups 1 and 2 were 88.3%, 59.2% and 48.1%, and 61.0%, 13.6% and 13.6%, respectively (P = 0.000). Multivariate analysis indicated that CA19-9/GGT, lymphatic metastasis and tumor differentiation were independent risk factors for tumor recurrence and long-term prognosis of DCC.CONCLUSIONElevation of CA19-9/GGT performed better as a biomarker of aggressive carcinoma and predictor of poor clinical outcomes by reducing the effect of obstruction of biliary tract on CA19-9 concentration in patients with DCC.     

术前血清CA19-9水平对乙肝相关性肝内胆管细胞癌根治术后预后影响分析

目的 评估术前血清糖类抗原19-9（carbohydrate antigen19-9,CA19-9）水平对乙肝相关性肝内胆管细胞癌（hepatitis B virus-associated intrahepatic cholangiocarcinoma,HBV-ICC）根治术后预后的影响。方法 连续收集我院2007年1月至2009年10月行手术根治治疗的143例HBV-ICC患者的临床及随访资料。根据术前CA19-9水平,将患者分为CA19-9升高组（＞37 U/mL）与CA19-9正常组（≤37 U/mL）, 并借助软件SPSS20.0比较两组的临床病理学和预后差异。结果 CA19-9升高组临床症状阳性率,ALT、碱性磷酸酶（alkaline phosphatase,ALP）、谷胺酰转肽酶（γ-glutamyltransferase,γ-GT）等术前水平明显高于CA19-9正常组（P＜0.05）,而且,CA19-9升高组更易出现淋巴结转移及微血管侵犯（P＜0.05）。CA19-9升高组与CA19-9正常组1、3和5年的总体生存率分别为82% vs 58%,65% vs 28%和52% vs 20%（P＜0.001）。CA19-9升高组与CA19-9正常组1、3和5年的无瘤生存率分别为69% vs 37%,51% vs 20%和45% vs 15%（P＜0.001）。结论 术前CA19-9水平升高是HBV-ICC患者根治性肝切除术后预后差的危险因素。     

Prognostic Impact of the Initial Postoperative CA19-9 Level in Patients with Extrahepatic Bile Duct Cancer

Background

The aim of this study was to investigate the prognostic impact of the initial serum postoperative CA19-9 levels in patients with extrahepatic bile duct cancer.

Methods

Data of a total of 143 patients of extrahepatic bile duct cancer with elevated preoperative serum CA19-9 levels (>37 U/ml) who underwent surgery with curative intent were reviewed retrospectively. The patients were divided into the “Normalization group” and “Non-normalization group” (initial postoperative serum CA19-9 ≤37 and >37 U/ml, respectively), and the clinicopathological factors and survival outcomes in these groups were comparatively analyzed.

Results

The cumulative 5-year overall survival (OS) rate and median survival time (MST) were 39.2 % and 42.9 months, respectively, in the Normalization group and 17.9 % and 24.0 months, respectively, in the Non-normalization group (P?<?0.001). Presence of jaundice, a poorer histological differentiation grade (G3–4), lymph node metastasis, and initial postoperative serum CA19-9 level (>37 U/ml) were significant independent predictors of a poor prognosis on multivariate analysis.

Conclusion

Non-normalization of the serum CA19-9 level in the initial postoperative phase is a strong predictor of a poor prognosis and is a useful marker to identify patients who would need additional treatments and stricter follow-up.

     

Preoperative serum carbohydrate antigen 19-9 levels predict early recurrence after the resection of early-stage pancreatic ductal adenocarcinoma

BACKGROUNDPancreatic ductal adenocarcinoma (PDAC) is a serious disease with a poor prognosis. Only a minority of patients undergo surgery due to the advanced stage of the disease, and patients with early-stage disease, who are expected to have a better prognosis, often experience recurrence. Thus, it is important to identify the risk factors for early recurrence and to develop an adequate treatment plan.AIMTo evaluate the predictive factors associated with the early recurrence of early-stage PDAC.METHODSThis study enrolled 407 patients with stage I PDAC undergoing upfront surgical resection between January 2000 and April 2016. Early recurrence was defined as a diagnosis of recurrence within 6 mo of surgery. The optimal cutoff values were determined by receiver operating characteristic (ROC) analyses. Univariate and multivariate analyses were performed to identify the risk factors for early recurrence.RESULTSOf the 407 patients, 98 patients (24.1%) experienced early disease recurrence: 26 (26.5%) local and 72 (73.5%) distant sites. In total, 253 (62.2%) patients received adjuvant chemotherapy. On ROC curve analysis, the optimal cutoff values for early recurrence were 70 U/mL and 2.85 cm for carbohydrate antigen 19-9 (CA 19-9) levels and tumor size, respectively. Of the 181 patients with CA 19-9 level > 70 U/mL, 59 (32.6%) had early recurrence, compared to 39 (17.4%) of 226 patients with CA 19-9 level ≤ 70 U/mL (P < 0.001). Multivariate analysis revealed that CA 19-9 level > 70 U/mL (P = 0.006), tumor size > 2.85 cm (P = 0.004), poor differentiation (P = 0.008), and non-adjuvant chemotherapy (P = 0.025) were significant risk factors for early recurrence in early-stage PDAC.CONCLUSIONElevated CA 19-9 level (cutoff value > 70 U/mL) can be a reliable predictive factor for early recurrence in early-stage PDAC. As adjuvant chemotherapy can prevent early recurrence, it should be recommended for patients susceptible to early recurrence.     

CA19-9 in Potentially Resectable Pancreatic Cancer: Perspective to Adjust Surgical and Perioperative Therapy

Purpose

In pancreatic cancer, genetic markers to aid clinical decision making are still lacking. The present study was designed to determine the prognostic role of perioperative serum tumor marker carbohydrate antigen 19-9 (CA19-9) in pancreatic adenocarcinoma, with a focus on implications for pre- and postoperative therapeutic consequences.

Methods

Of a total of 1,626 consecutive patients who underwent surgery for primary pancreatic adenocarcinoma, data from 1,543 patients with preoperative serum levels of CA19-9 were evaluated for tumor stage, resectability, and prognosis. Preoperative to postoperative CA19-9 changes were analyzed for long-term survival. A control cohort of 706 patients with chronic pancreatitis was used to assess the predictability of malignancy by CA19-9 and the effects of hyperbilirubinemia on CA19-9 levels.

Results

The more that preoperative CA19-9 increased, the lower were tumor resectability and survival rates. Resectability and 5-year survival varied from 80 to 38 % and from 27 to 0 % for CA19-9 <37 versus ≥4,000 U/ml, respectively. The R0 resection rate was as low as 15 % in all patients with CA19-9 levels ≥1,000 U/ml. CA19-9 increased with the stage of the disease and was highest in AJCC stage IV. Patients with an early postoperative CA19-9 increase had a dismal prognosis. Hyperbilirubinemia did not markedly affect CA19-9 levels (correlation coefficient ≤0.135).

Conclusions

In patients with pancreatic adenocarcinoma, CA19-9 predicts resectability, stage of disease, as well as survival. Highly elevated preoperative or increasing postoperative CA19-9 levels are associated with low resectability and poor survival rates, and demand the adjustment of surgical and perioperative therapy.     

术前白蛋白-胆红素评分以及其与CA19-9联合作为胰腺癌患者预后指标的临床价值

背景与目的:白蛋白-胆红素(ALBI)评分是用于评估肝细胞癌患者肝功能障碍严重程度的指标,但近来研究显示其与其他恶性肿瘤的预后也可能存在一定的关联。因此,本研究探讨术前ALBI评分以及ALBI评分与胰腺癌常用标志物糖类抗原19-9(CA19-9)联合应用作为胰腺癌患者预后指标的临床价值。方法:回顾性分析2010年1月—2014年11月期间辽宁省健康产业集团阜新矿总医院普通外科行胰腺癌切除术的97例患者临床资料。所有患者均术前当日测定血清白蛋白、总胆红素和CA19-9水平,分析患者血清白蛋白水平与胆红素浓度的相关性、ALBI评分与患者临床病理因素及CA19-9水平的关系、ALBI评分与CA19-9水平对患者预后的影响。结果:胰腺癌患者血清白蛋白水平与胆红素浓度呈明显相关性(r=0.45,P=0.018)。ALBI评分与患者术前是否因胆管梗阻行胆道引流术有关(P=0.008),而与患者CA19-9水平及其他临床病理因素均无明显关系(均P0.05)。高ALBI组患者5年生存率明显低于低ALBI组患者(22.2% vs.42.3%,P=0.036);高CA19-9组患者5年生存率明显低于低CA19-9组患者(24.1% vs.44.2%,P=0.035)。两者联合分析结果显示,高ALBI+高CA19-9(双高组)、高ALBI+低CA19-9(高ALBI组)、低ALBI和高CA19-9(高CA19-9组)、低ALBI+低CA19-9(双低组)患者的5年生存率分别为12.0%、35.0%、34.5%、52.2%;双高组患者5年生存率明显低于单高组(高ALBI组+高CA19-9组)和双低组(12.0% vs.34.7%,P=0.038;12.0% vs.52.2%,P=0.003),而后两组之间无统计学差异(P=0.159)。多因素分析显示,ALBI评分与CA19-9联合参数(P=0.009)及淋巴结转移(P=0.012)是胰腺癌患者预后的独立危险因素。结论:ALBI评分与胰腺癌患者的预后有一定的关联,ALBI评分与CA19-9水平的联合参数可作为独立预后因素用于胰腺癌患者的预后的评估,高ALBI评分同时CA19-9水平升高患者预后不良。