Yeo Seung-Gu, Kim Dae Yong, Kim Tae Hyun, Kim Sun Young, Baek Ji Yeon, Chang Hee Jin, Park Ji Won, Oh Jae Hwan
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea E-mail :
Asian Pac J Cancer Prev. 2014;15(13):5383-7. doi: 10.7314/apjcp.2014.15.13.5383.
To investigate whether pretreatment serum carbohydrate antigen 19-9 (CA 19-9) levels are associated with pathological responses to preoperative chemoradiotherapy (CRT) in patients with rectal cancer.
In total, 260 patients with locally advanced rectal cancer (cT3-4NanyM0) who underwent preoperative CRT and radical surgery were analyzed retrospectively. CRT consisted of 50.4 Gy pelvic radiotherapy and concurrent chemotherapy. Radical surgery was performed at a median of 7 weeks after CRT completion. Pathological CRT response criteria included downstaging (ypStage 0-I) and ypT0-1. A discrimination threshold of CA 19-9 level was determined using a receiver operating characteristics analysis.
The median CA 19-9 level was 8.0 (1.0-648.0) U/mL. Downstaging occurred in 94 (36.2%) patients and ypT0-1 in 50 (19.2%). The calculated optimal threshold CA 19-9 level was 10.2 U/mL for downstaging and 9.0 U/mL for ypT0-1. On multivariate analysis, CA 19-9 (≤ 9.0 U/mL) was significantly associated with downstaging (odds ratio, 2.089; 95% confidence interval, 1.189-3.669; P=0.010) or ypT0-1 (OR, 2.207; 95%CI, 1.079-4.512; P=0.030), independent of clinical stage or carcinoembryonic antigen.
This study firstly showed a significant association of pretreatment serum CA 19-9 levels with pathological CRT responses of rectal cancer. The CA 19-9 level is suggested to be valuable in predicting CRT responses of rectal cancer cases before treatment.
探讨术前血清糖类抗原19-9（CA 19-9）水平与直肠癌患者术前放化疗（CRT）病理反应是否相关。
回顾性分析260例接受术前CRT及根治性手术的局部晚期直肠癌（cT3-4NanyM0）患者。CRT包括50.4 Gy盆腔放疗及同步化疗。根治性手术在CRT结束后中位7周进行。病理CRT反应标准包括降期（yp分期0-I）及ypT0-1。使用受试者工作特征分析确定CA 19-9水平的鉴别阈值。
CA 19-9水平中位数为8.0（1.0-648.0）U/mL。94例（36.2%）患者出现降期，50例（19.2%）出现ypT0-1。计算得出降期的最佳阈值CA 19-9水平为10.2 U/mL，ypT0-1为9.0 U/mL。多因素分析显示，CA 19-9（≤9.0 U/mL）与降期（比值比，2.089；95%置信区间，1.189-3.669；P=0.010）或ypT0-1（OR，2.207；95%CI，1.079-4.512；P=0.030）显著相关，独立于临床分期或癌胚抗原。
本研究首次表明术前血清CA 19-9水平与直肠癌病理CRT反应显著相关。提示CA 19-9水平在预测直肠癌患者治疗前CRT反应方面具有价值。
