Marrelli Daniele, Caruso Stefano, Pedrazzani Corrado, Neri Alessandro, Fernandes Eduardo, Marini Mario, Pinto Enrico, Roviello Franco
Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico Le Scotte, Siena, Italy.
Am J Surg. 2009 Sep;198(3):333-9. doi: 10.1016/j.amjsurg.2008.12.031. Epub 2009 Apr 17.
Obstructive jaundice is frequently associated with false CA19-9 elevation in benign conditions. The diagnostic accuracy of this tumor marker was evaluated in the present longitudinal study.
In 128 patients admitted for obstructive jaundice (87 with pancreato-biliary malignancy and 41 benign disease) serum CA19-9 was measured. Statistical analysis of marker levels obtained before and after endoscopic biliary drainage was performed in 60 patients.
Elevated CA19-9 levels (>37 U/mL) were found in 61% of benign cases and 86% of malignancies. After biliary drainage, decrease of serum CA19-9 was observed in 19 of 38 malignant cases and in almost all benign cases (Wilcoxon matched pairs test: P = .207 and P <.001, respectively). Receiver operating characteristic (ROC) analysis identified a cut-off value of 90 U/mL to be associated with improved diagnostic accuracy after biliary drainage (sensitivity 61%, specificity 95%).
In the presence of successfully drained obstructive jaundice, CA19-9 serum levels that remain unchanged or measure more than 90 U/mL are strongly indicative of a malignant cause of obstruction. However, the real clinical utility of this marker remains controversial.
梗阻性黄疸在良性疾病中常伴有CA19-9假升高。在本纵向研究中评估了该肿瘤标志物的诊断准确性。
对128例因梗阻性黄疸入院的患者（87例胰胆恶性肿瘤和41例良性疾病）测定血清CA19-9。对60例患者内镜下胆管引流前后获得的标志物水平进行统计分析。
61%的良性病例和86%的恶性肿瘤病例CA19-9水平升高（>37 U/mL）。胆管引流后，38例恶性病例中有19例血清CA19-9下降，几乎所有良性病例血清CA19-9均下降（Wilcoxon配对检验：P分别为0.207和P<0.001）。受试者工作特征（ROC）分析确定，胆管引流后诊断准确性提高的临界值为90 U/mL（敏感性61%，特异性95%）。
在梗阻性黄疸成功引流的情况下，CA19-9血清水平保持不变或超过90 U/mL强烈提示梗阻的恶性原因。然而，该标志物的实际临床应用仍存在争议。
