Jin Xiaoli, Wu Yulian
Department of Surgery, Sir Run Run Shaw Hospital College of Medicine, Zhejiang University, 3 Qingchun Road East, Hangzhou, Zhejiang Province 310016, P.R. China
Department of Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, P.R. China.
Afr Health Sci. 2015 Mar;15(1):123-30. doi: 10.4314/ahs.v15i1.17.
Carbohydrate antigen (CA)19-9 that is the most widely used biomarker for pancreatic cancer has certain limitations in diagnosis, which results in a tough job to distinguish pancreatic cancer from benign tumors with normal CA19-9. The aim of this study was to investigate the diagnostic utility of clinical parameters and serum markers in patients with pancreatic head masses but without elevated CA19-9.
Retrospectively, 106 (69 malignant, 37 benign) of 487 patients admitted for pancreatic head masses were enrolled with CA19-9 level of <37u/ml. Clinical parameters and serum biomarkers were assessed. Among the patients with pancreatic head mass, male individuals (p=0.025) and elder individuals (p<0.001) were more likely to have cancer; and cancer patients were more likely to present with abdominal-pain (p=0.023), weight-loss (p=0.013) and jaundice (p<0.001). Serum bilirubin levels among malignancies, including total bilirubin (p<0.001), direct bilirubin (p<0.001) and indirect bilirubin (p<0.001), were considerably higher than those of benign ones. Logistic regression further concluded that age-distribution, abdominal-pain and direct-bilirubin were three independent factors correlating with final diagnosis. However, CEA (p=0.156) was not sufficient enough to exclude pancreatic cancer.
In patients with pancreatic head masses and CA19-9 of <37u/ml, age-distribution, abdominal-pain and direct bilirubin might be helpful in differential diagnosis. CEA was insufficient for exclusion of malignancy.
糖类抗原（CA）19-9是胰腺癌最常用的生物标志物，但在诊断方面存在一定局限性，这使得在CA19-9正常的情况下，很难将胰腺癌与良性肿瘤区分开来。本研究旨在探讨临床参数和血清标志物在胰头肿块但CA19-9未升高患者中的诊断价值。
回顾性分析487例因胰头肿块入院患者中106例（69例恶性，37例良性）CA19-9水平<37u/ml的患者。评估临床参数和血清生物标志物。在胰头肿块患者中，男性（p=0.025）和老年患者（p<0.001）更易患癌；癌症患者更易出现腹痛（p=0.023）、体重减轻（p=0.013）和黄疸（p<0.001）。恶性肿瘤患者的血清胆红素水平，包括总胆红素（p<0.001）、直接胆红素（p<0.001）和间接胆红素（p<0.001），明显高于良性肿瘤患者。逻辑回归进一步得出结论，年龄分布、腹痛和直接胆红素是与最终诊断相关的三个独立因素。然而，癌胚抗原（CEA，p=0.156）不足以排除胰腺癌。
在胰头肿块且CA19-9<37u/ml的患者中，年龄分布、腹痛和直接胆红素可能有助于鉴别诊断。CEA不足以排除恶性肿瘤。
