Rudnicki J, Agrawal A K, Grzebieniak Z, Zukrowski P, Zyśko D, Jelen M, Kielan W, Sebastian M, Słonina J, Marek G, Duda-Barcik Ł
Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical University, Poland.
Folia Histochem Cytobiol. 2010 Jan;48(2):249-61. doi: 10.2478/v10042-010-0034-y.
The prognosis in patients with pancreatic cancer is poor and some authors describe it as a lethal disease. At the time of diagnosis only 14% of patients could be surgically treated and up to 30% of them die within 12 months. Therefore, further clinical investigations on preoperative patient qualification are needed. A total of 81 patients were included into the study. The CA 19-9 concentration was measured before surgery by an automated, commercially available enzyme immunoassay in Axsym analyzer (Abott Diagnostics Laboratory). A value of 37 U/ml was used as the upper limit of normal levels. Tumors were staged according to the Union Against Cancer (UICC) of 2004 and graded during the histological evaluation according to the G0-G4 scale. All patients were monitored every three month via outpatient clinic visits. In the case of missing visit we contacted the families to establish the cause. We assessed perioperative, 12 month, 2 year and 5 year survival. Twelve moth, 2 year and 5 year survival were assessed in the whole studied population and in the group of patients with the exception of these who died during the perioperative period. The total five year survival was 6%. The median time of survival was 467 days (range: 163 - 586 days). The perioperative period was survived by 91.4% patients, 12 months were survived by 71.6% patients, 2 years were survived by 35.8% patients, 5 years were survived by 6.2% patients. The serum Ca 19-9 level was above the normal limit in 80.5% patients. ROC curve analysis revealed that CA 19-9 level of more than 106 U/ml was linked to 2 year survival with 79.3% sensitivity and 74.5% specificity. Preoperative level of CA 19-9 below 106U/ml represents a predictive factor of 2- and 5-year survival, independent of other factors, such as lower size of the tumor, absence of metastases to lymph nodes, female gender of patients. After exclusion of the patients who died in the perioperative period, no relationship could have been disclosed between preoperative CA 19-9 levels and one year survival. The observation points to the chance that patients with higher levels of CA 19-9 harbour micrometastases, the development of which is sufficiently slow to allow for a one-year survival of the patients but which increase the risk of death after two and five years.
胰腺癌患者的预后很差，一些作者将其描述为一种致命疾病。在确诊时，只有14%的患者能够接受手术治疗，其中高达30%的患者在12个月内死亡。因此，需要对术前患者资格进行进一步的临床研究。共有81名患者纳入该研究。术前通过Axsym分析仪（雅培诊断实验室）的自动化、市售酶免疫测定法测量CA 19-9浓度。以37 U/ml的值作为正常水平的上限。肿瘤根据2004年国际抗癌联盟（UICC）进行分期，并在组织学评估期间根据G0-G4分级标准进行分级。所有患者每三个月通过门诊就诊进行监测。如果患者错过就诊，我们会联系其家属以确定原因。我们评估了围手术期、12个月、2年和5年生存率。在整个研究人群以及除围手术期死亡患者之外的患者组中评估了12个月、2年和5年生存率。总的五年生存率为6%。生存时间中位数为467天（范围：163 - 586天）。91.4%的患者度过了围手术期，71.6%的患者存活了12个月，35.8%的患者存活了2年，6.2%的患者存活了5年。80.5%的患者血清CA 19-9水平高于正常上限。ROC曲线分析显示，CA 19-9水平超过106 U/ml与2年生存率相关，敏感性为79.3%，特异性为74.5%。术前CA 19-9水平低于106 U/ml是2年和5年生存率的预测因素，与其他因素无关，如肿瘤较小、无淋巴结转移、患者为女性。排除围手术期死亡的患者后，术前CA 19-9水平与一年生存率之间未发现相关性。该观察结果表明，CA 19-9水平较高的患者可能存在微转移，其发展足够缓慢，使患者能够存活一年，但会增加两年和五年后死亡的风险。
