Department of Thoracic Surgery, General Surgery and Oncology, Medical University of Lodz, Poland.
Arch Med Sci. 2013 Aug 30;9(4):677-83. doi: 10.5114/aoms.2013.36899. Epub 2013 Aug 8.
We would save many lives and spare a lot of suffering if we could only detect and accurately determine the character and TMN staging of pancreatic tumors (PTs). With improved diagnosis, we could offer specific treatment that would result in better treatment outcome. The aim of study was to determine the significance of neoplastic markers CA 19-9 and CEA for prognosis in inflammatory and carcinomatous PTs.
We based our research upon a group of 170 patients. The patients were treated in our Oncologic Surgery Department from January 2007 to December 2010 for PTs. The patients were divided into four groups depending on the character of the tumor and underwent the following treatments: group 1 - 34 patients with carcinoma of the ampulla of Vater, group 2 - 64 patients with PTs at different stages (1, 2, 3) according to TMN classification, group 3 - 62 patients with PTs at stage 4 on the TMN scale (unresectable tumors), group 4 - 28 patients with inflammatory PTs.
The results of Ca 19-9 in group 2 were 736.00 (25-75% 220.40-4285.00) ng/ml before surgery, 53.00 (25-75% 12.60-84.00) ng/ml in the 7 days after surgery, 29.4 (25-75% 7.90-113.00) ng/ml at day 30, and 119.00 (25-75% 96.30-621.00) ng/ml 3 months after the operation. These results were significantly higher than the control group but were significantly lower than the results for group 3 (unresectable tumors). The highest average concentration and median for CA 19-9 and CEA were noted in patients with unresectable PTs (the 3(rd) group). The average concentration for CEA was lowest in group 4, but much higher than the lab limits.
The sensitivity of the CA 19-9 marker may be as high as 88%. Values of CA 19-9 above 852 U/ml may indicate TNM stage 4, consistent with an unresectable PT. In the cases where CA 19-9 is within normal limits but C-reactive protein is above normal limits (often thirty times the upper limit), in comparison to the control group and to patients with pancreatic neoplasms, strong consideration should be given towards the inflammatory characteristics of the pancreatic changes and conservative treatment should be applied.
如果我们能够检测和准确确定胰腺肿瘤 (PTs) 的特征和 TMN 分期，我们将挽救许多生命并减轻许多痛苦。通过改善诊断，我们可以提供特定的治疗方法，从而获得更好的治疗效果。本研究的目的是确定肿瘤标志物 CA 19-9 和 CEA 在炎性和癌性 PTs 中的预后意义。
我们的研究基于 170 名患者。这些患者于 2007 年 1 月至 2010 年 12 月在我们的肿瘤外科部门接受了 PTs 的治疗。根据肿瘤的特征，患者被分为四组，并接受以下治疗：第 1 组 - 34 名壶腹癌患者，第 2 组 - 64 名处于不同阶段（1、2、3）的 PTs 患者根据 TMN 分类，第 3 组 - 62 名 TMN 分期为 4 期（不可切除肿瘤）的 PTs 患者，第 4 组 - 28 名患有炎性 PTs 的患者。
第 2 组患者术前 CA 19-9 结果为 736.00（25-75% 220.40-4285.00）ng/ml，术后 7 天为 53.00（25-75% 12.60-84.00）ng/ml，第 30 天为 29.4（25-75% 7.90-113.00）ng/ml，术后 3 个月为 119.00（25-75% 96.30-621.00）ng/ml。这些结果明显高于对照组，但明显低于第 3 组（不可切除肿瘤）。在不可切除 PTs 患者中，CA 19-9 和 CEA 的平均浓度和中位数最高。CEA 的平均浓度在第 4 组中最低，但远高于实验室限值。
CA 19-9 标志物的灵敏度可能高达 88%。CA 19-9 值高于 852 U/ml 可能表明 TNM 分期为 4 期，与不可切除的 PT 一致。在 CA 19-9 在正常范围内但 C-反应蛋白高于正常范围（通常是上限的三十倍）的情况下，与对照组和胰腺肿瘤患者相比，应强烈考虑胰腺变化的炎症特征，并应采用保守治疗。
