Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
J Gastrointest Surg. 2009 Oct;13(10):1791-7. doi: 10.1007/s11605-009-0916-5. Epub 2009 May 21.
To assess the outcome of patients with resectable pancreatic adenocarcinoma (PA) associated with high serum CA 19-9 levels.
From 2000 to 2007, 344 patients underwent pancreatoduodenectomy for PA. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after resolution of obstructive jaundice. Of these, 27 patients had high levels (400-899 IU/ml (HL)) and 26 patients had very high levels >or=900 IU/ml (VHL). Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group.
Median survival of the control group (n = 50) versus elevated group (n = 53) was 22 versus 15 months (p = 0.02) and overall 3-year survival was 32% versus 14% (p = 0.03). There was no statistical difference in the median and 3-year overall survival between patients with HL and VHL. Patients in the elevated group who normalized their CA 19-9 levels after surgery (n = 11) had a survival equivalent to patients in the control group.
Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.
评估伴有高血清 CA19-9 水平的可切除胰腺腺癌（PA）患者的预后。
2000 年至 2007 年，344 例患者因 PA 行胰十二指肠切除术。53 例（升高组）患者在解除梗阻性黄疸后术前血清 CA19-9 水平升高（>400IU/ml）。其中 27 例患者水平较高（400-899IU/ml（HL）），26 例患者水平非常高>or=900IU/ml（VHL）。50 例术前血清 CA19-9 水平正常（<37IU/ml）的患者为对照组。
对照组（n=50）与升高组（n=53）的中位生存时间分别为 22 个月与 15 个月（p=0.02），总 3 年生存率分别为 32%与 14%（p=0.03）。HL 与 VHL 患者的中位和总 3 年生存率无统计学差异。术后 CA19-9 水平正常化的升高组患者（n=11）的生存与对照组患者相当。
术后 CA19-9 水平正常化的患者与术前 CA19-9 水平正常的患者具有相当的生存。术前血清 CA19-9 水平本身不应排除在术前仔细分期后进行手术的患者。
