Kim H J, Kim M H, Myung S J, Lim B C, Park E T, Yoo K S, Seo D W, Lee S K, Min Y I
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Am J Gastroenterol. 1999 Jul;94(7):1941-6. doi: 10.1111/j.1572-0241.1999.01234.x.
Clinicians might be misled in interpreting an elevated CA19-9 when differentiating pancreaticobiliary cancer from benign clinical conditions such as acute cholangitis or cholestasis, because in these conditions, the concentration of CA19-9 may also be elevated. The aims of our study were to calculate new individual cutoff values for CA19-9 according to clinical situations using a receiver operating characteristic (ROC) curve and to define a new strategy for interpreting CA19-9 in pancreaticobiliary cancer.
One hundred sixty patients with pancreatic diseases (cancer 90, benign disease 70), 322 patients with biliary tract diseases (biliary cancer 152, benign disease 170), and 20,035 asymptomatic controls were enrolled in the present study. An ROC curve was described by plotting the sensitivity on the y-axis against 1-specificity on the x-axis for each of several cutoff values.
The area under the ROC curve was significantly greater for pancreatic cancer than for biliary cancer (p < 0.05). For patients with pancreatic cancer, CA19-9 proved to be useful. At a cutoff value of 37 U/ml, sensitivity and specificity were 76.7% and 87.1%, respectively. For patients with biliary cancer, CA19-9 was not helpful. However, when patients with biliary disease were divided into two groups according to the presence of cholangitis or cholestasis, CA19-9 proved to be more useful for the group without cholangitis or cholestasis than for the group with cholangitis or cholestasis (p < 0.05). In the former group, the sensitivity and specificity of CA19-9 were 77.6% and 83%, respectively, at the cutoff value of 37 U/ml. For the latter group, the sensitivity and specificity of CA19-9 were 74% and 41.5% respectively, whereas the specificity reached 87% at 300 U/ml. CA19-9 in diagnosing pancreatic cancer was useful regardless of accompanying acute pancreatitis or cholestasis. The serum concentration of CA19-9 in asymptomatic individuals was 9.42 +/- 9.95 U/ml. Only 1 of 157 patients with a concentration of CA19-9 above 37 U/ml was found to have gallbladder cancer. The positive and negative predictive values were 0.65% and 0.78%, respectively.
The use of CA19-9 for the differentiation of pancreaticobiliary cancer should be applied individually, depending on the clinical situation.
在区分胰胆管癌与急性胆管炎或胆汁淤积等良性临床病症时，临床医生在解读升高的CA19-9时可能会被误导，因为在这些病症中，CA19-9的浓度也可能升高。我们研究的目的是使用受试者操作特征（ROC）曲线根据临床情况计算CA19-9的新的个体临界值，并确定一种在胰胆管癌中解读CA19-9的新策略。
本研究纳入了160例胰腺疾病患者（癌症90例，良性疾病70例）、322例胆道疾病患者（胆管癌152例，良性疾病170例）以及20035例无症状对照者。通过针对几个临界值中的每一个，将y轴上的敏感性与x轴上的1-特异性作图来描述ROC曲线。
胰腺癌的ROC曲线下面积显著大于胆管癌（p<0.05）。对于胰腺癌患者，CA19-9被证明是有用的。在临界值为37 U/ml时，敏感性和特异性分别为76.7%和87.1%。对于胆管癌患者，CA19-9没有帮助。然而，当根据是否存在胆管炎或胆汁淤积将胆道疾病患者分为两组时，CA19-9被证明对无胆管炎或胆汁淤积组比有胆管炎或胆汁淤积组更有用（p<0.05）。在前一组中，在临界值为37 U/ml时，CA19-9的敏感性和特异性分别为77.6%和83%。对于后一组，CA19-9的敏感性和特异性分别为74%和41.5%，而在300 U/ml时特异性达到87%。无论是否伴有急性胰腺炎或胆汁淤积，CA19-9在诊断胰腺癌中都是有用的。无症状个体的血清CA19-9浓度为9.42±9.95 U/ml。在157例CA19-9浓度高于37 U/ml的患者中，仅1例被发现患有胆囊癌。阳性和阴性预测值分别为0.65%和0.78%。
CA19-9用于区分胰胆管癌应根据临床情况个体化应用。
