Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
Ann Surg Oncol. 2013 Jul;20(7):2188-96. doi: 10.1245/s10434-012-2809-1. Epub 2012 Dec 18.
In pancreatic cancer, genetic markers to aid clinical decision making are still lacking. The present study was designed to determine the prognostic role of perioperative serum tumor marker carbohydrate antigen 19-9 (CA19-9) in pancreatic adenocarcinoma, with a focus on implications for pre- and postoperative therapeutic consequences.
Of a total of 1,626 consecutive patients who underwent surgery for primary pancreatic adenocarcinoma, data from 1,543 patients with preoperative serum levels of CA19-9 were evaluated for tumor stage, resectability, and prognosis. Preoperative to postoperative CA19-9 changes were analyzed for long-term survival. A control cohort of 706 patients with chronic pancreatitis was used to assess the predictability of malignancy by CA19-9 and the effects of hyperbilirubinemia on CA19-9 levels.
The more that preoperative CA19-9 increased, the lower were tumor resectability and survival rates. Resectability and 5-year survival varied from 80 to 38 % and from 27 to 0 % for CA19-9 <37 versus ≥4,000 U/ml, respectively. The R0 resection rate was as low as 15 % in all patients with CA19-9 levels ≥1,000 U/ml. CA19-9 increased with the stage of the disease and was highest in AJCC stage IV. Patients with an early postoperative CA19-9 increase had a dismal prognosis. Hyperbilirubinemia did not markedly affect CA19-9 levels (correlation coefficient ≤0.135).
In patients with pancreatic adenocarcinoma, CA19-9 predicts resectability, stage of disease, as well as survival. Highly elevated preoperative or increasing postoperative CA19-9 levels are associated with low resectability and poor survival rates, and demand the adjustment of surgical and perioperative therapy.
在胰腺癌中，仍缺乏有助于临床决策的遗传标志物。本研究旨在确定围手术期血清肿瘤标志物碳水化合物抗原 19-9（CA19-9）在胰腺腺癌中的预后作用，重点关注其对术前和术后治疗结果的影响。
在总共 1626 例接受原发性胰腺腺癌手术的患者中，评估了 1543 例术前 CA19-9 血清水平患者的肿瘤分期、可切除性和预后数据。分析了术前至术后 CA19-9 变化与长期生存的关系。使用 706 例慢性胰腺炎患者的对照组评估 CA19-9 对恶性肿瘤的预测性以及高胆红素血症对 CA19-9 水平的影响。
术前 CA19-9 升高越多，肿瘤可切除性和生存率越低。可切除性和 5 年生存率分别为 80%至 38%和 27%至 0%，CA19-9 <37 与≥4000 U/ml 相比。所有 CA19-9 水平≥1000 U/ml 的患者中，R0 切除率低至 15%。CA19-9 随疾病分期而增加，在 AJCC 分期 IV 中最高。术后早期 CA19-9 升高的患者预后较差。高胆红素血症不会明显影响 CA19-9 水平（相关系数≤0.135）。
在胰腺腺癌患者中，CA19-9 可预测可切除性、疾病分期以及生存情况。术前或术后升高的 CA19-9 水平与可切除性低和生存率低相关，需要调整手术和围手术期治疗。
