Tian F, Appert H E, Myles J, Howard J M
Department of Surgery, Medical College of Ohio, Toledo.
Ann Surg. 1992 Apr;215(4):350-5. doi: 10.1097/00000658-199204000-00008.
Thirty-eight patients with histologically proven pancreatic adenocarcinoma were investigated to establish the utility of serum CA 19-9 as a prognostic indicator. CA 19-9 assays were performed serially during the course of the disease. In four patients with negative Lewis blood type, the CA 19-9 levels remained essentially normal throughout the disease course. In the remaining 34 patients, (1) CA 19-9 levels were significantly lower in patients with tumor size no larger than 5 cm in diameter, and in patients with resectable tumors than in those with tumor size larger than 5 cm or with unresectable tumors (p less than 0.01). 2) CA 19-9 levels dropped sharply after resection in all 11 resectable patients, whereas no significant change was found after laparotomy without resection. (3) The average survival time in seven patients whose CA 19-9 levels returned to normal after resection was significantly longer than in those four patients with postoperative CA 19-9 levels that decreased but did not return to normal (21.9 versus 8.7 months, p less than 0.05). (4) In 6 of 11 patients who underwent resection, recurrent elevation of CA 19-9 preceded changes detectable by computed tomography or clinical examination by 2 to 9 months. (5) In 23 patients who died of pancreatic carcinoma, 15 (65%) had an obvious rise in CA 19-9 level before death. There was a correlation between the doubling time of the CA 19-9 serum level and survival time (r = 0.5, p less than 0.05). Because it can be demonstrated that the reduction of tumor burden by resection lowers serum CA 19-9 levels, serum CA 19-9 levels may be a useful indicator of whether other forms of treatment such as radiation therapy or chemotherapy also reduce the tumor burden.
对38例经组织学证实的胰腺腺癌患者进行研究，以确定血清CA 19-9作为预后指标的实用性。在疾病过程中连续进行CA 19-9检测。4例Lewis血型阴性的患者，其CA 19-9水平在整个疾病过程中基本保持正常。在其余34例患者中，(1)肿瘤直径不大于5 cm的患者以及可切除肿瘤患者的CA 19-9水平显著低于肿瘤直径大于5 cm或不可切除肿瘤的患者(p<0.01)。(2)所有11例可切除患者术后CA 19-9水平急剧下降，而未切除的剖腹手术后未发现明显变化。(3)7例切除后CA 19-9水平恢复正常的患者的平均生存时间显著长于4例术后CA 19-9水平下降但未恢复正常的患者(21.9个月对8.7个月，p<0.05)。(4)11例接受切除的患者中有6例，CA 19-9的复发升高比计算机断层扫描或临床检查可检测到的变化提前2至9个月。(5)在23例死于胰腺癌的患者中，15例(65%)在死亡前CA 19-9水平明显升高。CA 19-9血清水平的倍增时间与生存时间之间存在相关性(r = 0.5，p<0.05)。由于可以证明切除减轻肿瘤负荷会降低血清CA 19-9水平，血清CA 19-9水平可能是放疗或化疗等其他治疗形式是否也能减轻肿瘤负荷的有用指标。
