Smith R A, Bosonnet L, Ghaneh P, Raraty M, Sutton R, Campbell F, Neoptolemos J P
Division of Surgery and Oncology, School of Cancer Studies, University of Liverpool, Liverpool, UK.
Dig Surg. 2008;25(3):226-32. doi: 10.1159/000140961. Epub 2008 Jun 24.
The aim of this study was to identify whether preoperative CA19-9 levels might represent an independent prognostic marker for overall survival in patients undergoing resection for pancreatic ductal adenocarcinoma, and to describe the relationship between CA19-9 and tumour histology.
109 patients who had a pancreatoduodenectomy for pancreatic ductal adenocarcinoma with recorded preoperative CA19-9 levels were identified from a prospectively maintained database (1997-2006). Multivariate analysis was conducted using a Cox proportional hazards model with continuous covariates where possible.
The median survival of 64 patients with a preoperative CA19-9 level >150 kU/l was 10.4 months while in 45 patients with a CA19-9 level <or=150 kU/l this was 22.1 months (corrected p = 0.012). Also significant on univariate analyses were overall lymph node status (p = 0.011), lymph node ratio (p = 0.003) and tumour diameter (p = 0.004). Preoperative CA19-9 levels >150 kU/l were associated with a larger, more poorly differentiated tumour along with an increased likelihood of a positive resection margin status (all p < 0.05). Preoperative CA19-9 levels (p = 0.030) and lymph node ratio (p = 0.042) emerged as independent predictors of survival on multivariate analysis.
Preoperative CA19-9 levels and lymph node ratio were significant predictors of survival in resected pancreatic ductal adenocarcinoma.
本研究旨在确定术前CA19-9水平是否可作为接受胰腺导管腺癌切除术患者总生存期的独立预后标志物，并描述CA19-9与肿瘤组织学之间的关系。
从一个前瞻性维护的数据库（1997 - 2006年）中识别出109例行胰腺导管腺癌胰十二指肠切除术且记录了术前CA19-9水平的患者。尽可能使用带有连续协变量的Cox比例风险模型进行多变量分析。
术前CA19-9水平>150 kU/l的64例患者的中位生存期为10.4个月，而CA19-9水平≤150 kU/l的45例患者的中位生存期为22.1个月（校正p = 0.012）。单变量分析中具有显著意义的还有总体淋巴结状态（p = 0.011）、淋巴结比率（p = 0.003）和肿瘤直径（p = 0.004）。术前CA19-9水平>150 kU/l与更大、分化更差的肿瘤以及切缘阳性状态的可能性增加相关（所有p < 0.05）。在多变量分析中，术前CA19-9水平（p = 0.030）和淋巴结比率（p = 0.042）成为生存的独立预测因素。
术前CA19-9水平和淋巴结比率是切除的胰腺导管腺癌患者生存的重要预测因素。
