Steinberg W
Department of Medicine, George Washington University Medical Center, Washington, DC.
Am J Gastroenterol. 1990 Apr;85(4):350-5.
Since Koprowski and coworkers discovered the CA 19-9 antigen 10 yr ago, it has become the most useful blood test in the diagnosis and management of patients with cancer of the pancreas. With an upper limit of normal of 37 U/ml, the assay's overall sensitivity is approximately 80% and its specificity is 90%. If higher cutoffs are used, the specificity rises so that, at levels greater than 1000 U/ml, the marker's specificity approaches 100%. Acute cholangitis and cirrhosis are two benign conditions that might raise this assay significantly. This tumor-associated marker is also helpful in predicting unresectability of pancreatic adenocarcinoma, as 96% of tumors that result in blood levels greater than 1000 U/ml have been found to be unresectable. After potentially curative surgery, the CA 19-9 can help prognosticate survival. Patients who normalize their CA 19-9 postoperatively live longer than those who do not. Furthermore, the assay, when used serially, predicts recurrence of disease prior to radiographic or clinical findings. The CA 19-9 is currently the "gold" standard marker for pancreatic cancer, against which other assays in this field will be judged.
自10年前科普罗夫斯基及其同事发现CA 19-9抗原以来，它已成为胰腺癌患者诊断和管理中最有用的血液检测指标。该检测的正常上限为37 U/ml，其总体敏感性约为80%，特异性为90%。如果采用更高的临界值，特异性会提高，以至于在大于1000 U/ml的水平时，该标志物的特异性接近100%。急性胆管炎和肝硬化是可能使该检测结果显著升高的两种良性疾病。这种肿瘤相关标志物在预测胰腺腺癌不可切除性方面也有帮助，因为已发现96%导致血液水平大于1000 U/ml的肿瘤是不可切除的。在进行了可能治愈性的手术后，CA 19-9有助于预测生存情况。术后CA 19-9恢复正常的患者比未恢复正常的患者寿命更长。此外，该检测连续使用时，可在影像学或临床发现之前预测疾病复发。CA 19-9目前是胰腺癌的“金”标准标志物，该领域的其他检测将以此为参照进行评判。
