吉西他滨为基础的化疗期间，CA 19-9动力学在晚期胆管癌患者中的预后价值

Prognostic value of CA 19-9 kinetics during gemcitabine-based chemotherapy in patients with advanced cholangiocarcinoma.

作者信息

Lee Ban Seok, Lee Sang Hyub, Son Jun Hyuk, Jang Dong Kee, Chung Kwang Hyun, Paik Woo Hyun, Ryu Ji Kon, Kim Yong-Tae

机构信息

Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul.

Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang, South Korea.

出版信息

J Gastroenterol Hepatol. 2016 Feb;31(2):493-500. doi: 10.1111/jgh.13059.

DOI:10.1111/jgh.13059

PMID:26220764

Abstract

BACKGROUND

Little is known of the prognostic value of CEA/CA 19-9 kinetics during chemotherapy in patients with advanced cholangiocarcinoma (CCA).

METHODS

A total of 236 patients with pathologically confirmed advanced CCA received gemcitabine-based chemotherapy were reviewed, and 179 were eligible for analysis. Baseline, pre-, and post-treatment (after two cycles of chemotherapy) CEA and CA 19-9 values were checked, and survival was compared according to various cutting points of baseline measurement or extent of change of tumor marker level.

RESULTS

Patients with a ≥ 50% decline in CA 19-9 level had better survival than the others (16.0 vs 9.0 months). However, CEA decline did not predict survival gain. Significant favorable prognostic factors of survival in multivariable analysis included initial treatment response (HR 0.61), distal location of tumor (HR 0.46), baseline CA 19-9 level ≤ 1000 U/mL (HR 0.58), and ≥ 50% decline in CA 19-9 level (HR 0.50). Subgroup analysis was conducted in 114 patients with pre-treatment CA 19-9 > 37 U/mL and bilirubin ≤ 2 mg/dL. Decline ≥ 50% in CA 19-9 level still showed an independent prognostic significance (HR 0.45).

CONCLUSION

CA 19-9 but not CEA kinetics serves as a predictor of better survival in patients with advanced CCA on gemcitabine-based chemotherapy. A ≥ 50% decline in CA 19-9 level after two cycles of chemotherapy may have clinical utility as an early indicator of better response to gemcitabine-based chemotherapy.

摘要

背景

关于晚期胆管癌（CCA）患者化疗期间癌胚抗原（CEA）/糖类抗原19-9（CA 19-9）动力学的预后价值，人们所知甚少。

方法

回顾了总共236例经病理证实为晚期CCA且接受了以吉西他滨为基础的化疗的患者，其中179例符合分析条件。检查了基线、化疗前和化疗后（两个化疗周期后）的CEA和CA 19-9值，并根据基线测量的不同切点或肿瘤标志物水平的变化程度比较了生存率。

结果

CA 19-9水平下降≥50%的患者比其他患者生存期更长（16.0个月对9.0个月）。然而，CEA下降并不能预测生存期延长。多变量分析中生存的显著有利预后因素包括初始治疗反应（风险比[HR] 0.61）、肿瘤远端位置（HR 0.46）、基线CA 19-9水平≤1000 U/mL（HR 0.58）以及CA 19-9水平下降≥50%（HR 0.50）。对114例化疗前CA 19-9>37 U/mL且胆红素≤2 mg/dL的患者进行了亚组分析。CA 19-9水平下降≥50%仍显示出独立的预后意义（HR 0.45）。