Huang Li, Chen Wei, Liang Peiwen, Hu Wenjie, Zhang Kunsong, Shen Shunli, Chen Jiancong, Zhang Zhaohui, Chen Bin, Han Yuyan, Meng Fanyin, DeMorrow Sharon, Yin Xiaoyu, Lai Jiaming, Liang Lijian
Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Dig Dis Sci. 2015 May;60(5):1273-83. doi: 10.1007/s10620-014-3472-0. Epub 2014 Dec 9.
Biliary tract cancers encompass gallbladder carcinoma, and intrahepatic, perihilar and distal cholangiocarcinoma. Upregulated serum CYFRA 21-1 has been reported in intrahepatic cholangiocarcinoma.
The present study aimed to explore the clinical significance of serum CYFRA 21-1 in all biliary tract cancer subtypes.
Serum CYFRA 21-1, carbohydrate antigen 19-9 and carcinoembryonic antigen were quantitated preoperatively, postoperatively and during follow-up in 134 malignant and 52 benign patients. Receiver operator characteristic curves of biomarkers were analyzed. Level of CYFRA 21-1 was correlated with patients' clinicopathological features and follow-up data.
CYFRA 21-1 was significantly upregulated in biliary malignancies, and expressional difference existed between these subtypes. Based on the maximal Youden's index, cutoff values were selected (ng/mL): 2.61 for biliary tract cancers (sensitivity 74.6 % and specificity 84.6 %); 3.27 for intrahepatic cholangiocarcinoma (75.6 and 96.2 %) and gallbladder carcinoma (93.7 and 96.2 %); 2.27 for perihilar cholangiocarcinoma (71.0 and 71.2 %); and 2.61 for distal cholangiocarcinoma (63.3 and 84.6 %). CYFRA 21-1 showed better diagnostic performance than other biomarkers in gallbladder carcinoma and intrahepatic cholangiocarcinoma; its performance was not inferior to that of the combination of these three biomarkers and declined after curative resection and re-elevated when tumor recurred, which was correlated with tumor aggressiveness and TNM stage; it was an independent predictor for 1-year recurrence-free survival and overall survival on multivariate analysis.
Serum CYFRA 21-1 represents a reliable biomarker for gallbladder carcinoma and intrahepatic cholangiocarcinoma.
胆道癌包括胆囊癌、肝内胆管癌、肝门部胆管癌和肝外胆管癌。已有报道称肝内胆管癌患者血清CYFRA 21-1水平上调。
本研究旨在探讨血清CYFRA 21-1在所有胆道癌亚型中的临床意义。
对134例恶性患者和52例良性患者在术前、术后及随访期间进行血清CYFRA 21-1、糖类抗原19-9和癌胚抗原定量检测。分析生物标志物的受试者工作特征曲线。CYFRA 21-1水平与患者的临床病理特征及随访数据相关。
CYFRA 21-1在胆道恶性肿瘤中显著上调，且各亚型之间存在表达差异。根据最大约登指数选择临界值（ng/mL）：胆道癌为2.61（敏感性74.6%，特异性84.6%）；肝内胆管癌和胆囊癌为3.27（75.6%和96.2%）；肝门部胆管癌为2.27（71.0%和71.2%）；肝外胆管癌为2.61（63.3%和84.6%）。CYFRA 21-1在胆囊癌和肝内胆管癌中的诊断性能优于其他生物标志物；其性能不低于这三种生物标志物联合检测，根治性切除后下降，肿瘤复发时再次升高，这与肿瘤侵袭性和TNM分期相关；多因素分析显示，它是1年无复发生存率和总生存率的独立预测指标。
血清CYFRA 21-1是胆囊癌和肝内胆管癌的可靠生物标志物。
