Tessler David A, Catanzaro Andrew, Velanovich Vic, Havstad Suzanne, Goel Sachin
Department of Internal Medicine, Division of Gastroenterology, Henry Ford Hospital, Gastroenterology, K-7, 2799 West Grand Blvd., Detroit, MI 48202, USA.
Am J Surg. 2006 Feb;191(2):191-7. doi: 10.1016/j.amjsurg.2005.08.029.
The aim of this study was to identify predictive factors for malignancy in patients undergoing surgery for suspected pancreatic cancer without a preoperative tissue diagnosis.
Patients were identified by International Classification of Diseases Ninth Revision and current procedural terminology codes, respectively, for pancreatic cancer and pancreaticoduodenectomy at a single tertiary referral center between January 1998 and May 2004. Data were collected retrospectively by chart review. Multivariate analysis of potential predictive factors was performed.
A total of 150 patients underwent surgery for documented or suspected pancreatic malignancy; 102 did not have a preoperative tissue diagnosis of cancer. Of these, 75 had neoplastic disease at surgery. Average weight loss was greater for those with malignancy (13.5 vs. 4.8 lbs; P = .014) as was mean bilirubin (6.1 vs. 3.3 mg/dL; P = .006). In multivariate analysis, a combination of weight loss >20 lbs, bilirubin >3 mg/dL, and CA 19-9 >37 U/mL had both a specificity and positive predictive value of 100% for predicting malignancy regardless of bile duct abnormalities or mass lesions on endoscopic retrograde cholangiopancreatography or endoscopic ultrasound, respectively. The positive predictive value decreased to 89.5% when any 2 of these findings were present. The presence of a mass on CT or EUS alone had a sensitivity of 84%; however, no other single finding had a sensitivity >65%.
In patients suspected of having a pancreatic malignancy, weight loss, hyperbilirubinemia, and increased CA 19-9 level may be predictive of a final cancer diagnosis. Surgical exploration should be considered in these patients even in the absence of a preoperative tissue diagnosis.
本研究的目的是确定在未进行术前组织诊断的疑似胰腺癌患者中，预测恶性肿瘤的因素。
分别通过国际疾病分类第九版和当前手术操作术语编码，在一家单一的三级转诊中心识别出1998年1月至2004年5月期间接受胰腺癌手术和胰十二指肠切除术的患者。通过查阅病历回顾性收集数据。对潜在的预测因素进行多变量分析。
共有150例患者接受了确诊或疑似胰腺恶性肿瘤的手术；102例患者术前未进行癌症组织诊断。其中，75例患者手术时患有肿瘤性疾病。恶性肿瘤患者的平均体重减轻更多（13.5磅对4.8磅；P = 0.014），平均胆红素水平也是如此（6.1毫克/分升对3.3毫克/分升；P = 0.006）。在多变量分析中，体重减轻>20磅、胆红素>3毫克/分升和CA 19-9>37 U/mL的组合，无论内镜逆行胰胆管造影或内镜超声检查时是否存在胆管异常或肿块病变，对预测恶性肿瘤的特异性和阳性预测值均为100%。当出现这些发现中的任意两项时，阳性预测值降至89.5%。仅CT或EUS上出现肿块的敏感性为84%；然而，没有其他单一发现的敏感性>65%。
在疑似胰腺恶性肿瘤的患者中，体重减轻、高胆红素血症和CA 19-9水平升高可能预示最终的癌症诊断。即使在没有术前组织诊断的情况下，也应考虑对这些患者进行手术探查。
