Kim Jee-Eun, Lee Kyu Taek, Lee Jong Kyun, Paik Seung Woon, Rhee Jong Chul, Choi Kyoo Wan
Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2004 Feb;19(2):182-6. doi: 10.1111/j.1440-1746.2004.03219.x.
Although the prognosis for pancreatic cancer is generally poor, it is well known that the survival rate for resected pancreatic cancer is much higher than that for more conservative treatment. The importance of early detection is emphasized for resection of pancreatic cancer. Measurement of serum carbohydrate antigen (CA) 19-9 has shown satisfactory sensitivity and predictive value in symptomatic patients, but no available data has been found on healthy asymptomatic subjects. Thus, the authors aimed to determine the clinical usefulness of CA 19-9 as a screening tool for pancreatic cancer in asymptomatic subjects.
From December 1994 to November 2000, 70 940 asymptomatic persons visiting the Health Promotion Center at the Samsung Medical Center, Seoul, Korea, participated. All subjects underwent abdominal ultrasonography and serum CA 19-9 measurement. The authors analyzed the sensitivity, specificity, and predictive values of CA 19-9 for detecting pancreatic cancer. Also, those subjects who had a serum CA 19-9 level above the cut-off value were followed up using a serial check of CA 19-9, computed tomography, or endoscopic retrograde cholangiopancreatography.
The number of subjects with a level of CA 19-9 above the cutoff of 37 U/mL was 1063 (1.5%), including four cases diagnosed with pancreatic cancer. The prevalence of pancreatic cancer over the age of 30 years is 13.66 per 100 000 population in Korea. Therefore, the sensitivity is 100% and the specificity 98.5%. However, the positive predictive value of CA 19-9 for detecting pancreatic cancer is only 0.9% in the asymptomatic population.
Mass screening for pancreatic cancer using CA 19-9 levels in asymptomatic subjects is ineffective because of a very low positive predictive value, despite its high sensitivity and specificity.
尽管胰腺癌的总体预后通常较差，但众所周知，接受手术切除的胰腺癌患者的生存率远高于采用更保守治疗的患者。强调早期检测对于胰腺癌手术切除的重要性。血清糖类抗原（CA）19-9的检测在有症状的患者中显示出令人满意的敏感性和预测价值，但尚未发现关于健康无症状受试者的可用数据。因此，作者旨在确定CA 19-9作为无症状受试者胰腺癌筛查工具的临床实用性。
1994年12月至2000年11月，韩国首尔三星医疗中心健康促进中心的70940名无症状者参与研究。所有受试者均接受腹部超声检查和血清CA 19-9检测。作者分析了CA 19-9检测胰腺癌的敏感性、特异性和预测价值。此外，对血清CA 19-9水平高于临界值的受试者进行CA 19-9的系列检查、计算机断层扫描或内镜逆行胰胆管造影随访。
CA 19-9水平高于37 U/mL临界值的受试者有1063例（1.5%），其中4例被诊断为胰腺癌。在韩国，30岁以上人群中胰腺癌的患病率为每10万人13.66例。因此，敏感性为100%，特异性为98.5%。然而，在无症状人群中，CA 19-9检测胰腺癌的阳性预测值仅为0.9%。
在无症状受试者中使用CA 19-9水平进行胰腺癌大规模筛查无效，因为尽管其敏感性和特异性较高，但阳性预测值非常低。
