Luo Guopei, Jin Kaizhou, Guo Meng, Cheng He, Liu Zuqiang, Xiao Zhiwen, Lu Yu, Long Jiang, Liu Liang, Xu Jin, Liu Chen, Gao Yutang, Ni Quanxing, Yu Xianjun
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China; Department of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China; Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China.
Department of Epidemiology, Shanghai Cancer Institute, Shanghai 200032, P.R. China.
Oncol Lett. 2017 Feb;13(2):881-886. doi: 10.3892/ol.2016.5501. Epub 2016 Dec 14.
Pancreatic cancer remains a l disease that responds poorly to multiple types of treatment. Therefore, the identification of distinct subgroups that exhibit unique therapeutic responses is an urgent requirement. In the present multicenter study (1,912 cases), the differences between the therapeutic responses and clinical characteristics of two subgroups of pancreatic cancer, carbohydrate antigen 19-9 (CA19-9)-normal (baseline serum level, ≤37 U/ml) and CA19-9-elevated (baseline serum level, >37 U/ml), were analyzed. CA19-9-normal expression was identified to be an independent prognostic factor for patients with stage I-II [hazard ratio (HR)=0.77; P=0.037] and stage III-IV (HR=0.68; P<0.001) pancreatic cancer. The 5-year survival rate of the stage III-IV CA19-9-normal subgroup was increased compared with the stage I-II CA19-9-elevated subgroup (15.4 vs. 13.8%). In the stage I-II CA19-9-normal and CA19-9-elevated subgroups, gemcitabine-based chemotherapy was a significant positive prognostic factor for survival (CA19-9-normal, HR=0.54, P=0.013; CA19-9-elevated, HR=0.55, P<0.001). However, among stage III-IV patients, the CA19-9-normal subgroup exhibited a poor response to gemcitabine-based chemotherapy (HR=0.77; P=0.165), while the CA19-9-elevated subgroup exhibited a favorable response, resulting in a lower rate of mortality (HR=0.70; P<0.001) compared with no chemotherapy. It was concluded that CA19-9-normal pancreatic cancer is a less aggressive subgroup; however, advanced CA19-9-normal pancreatic cancer exhibits a poorer response to gemcitabine-based chemotherapy.
胰腺癌仍然是一种对多种治疗方法反应不佳的疾病。因此，识别出表现出独特治疗反应的不同亚组是一项迫切需求。在本多中心研究（1912例病例）中，分析了胰腺癌两个亚组，即糖类抗原19-9（CA19-9）正常（基线血清水平，≤37 U/ml）和CA19-9升高（基线血清水平，>37 U/ml）的治疗反应和临床特征之间的差异。CA19-9正常表达被确定为I-II期（风险比[HR]=0.77；P=0.037）和III-IV期（HR=0.68；P<0.001）胰腺癌患者的独立预后因素。III-IV期CA19-9正常亚组的5年生存率与I-II期CA19-9升高亚组相比有所提高（15.4%对13.8%）。在I-II期CA19-9正常和CA19-9升高亚组中，基于吉西他滨的化疗是生存的显著阳性预后因素（CA19-9正常，HR=0.54，P=0.013；CA19-9升高，HR=0.55，P<0.001）。然而，在III-IV期患者中，CA19-9正常亚组对基于吉西他滨的化疗反应不佳（HR=0.77；P=0.165），而CA19-9升高亚组反应良好，与未化疗相比死亡率较低（HR=0.70；P<0.001）。结论是，CA19-9正常的胰腺癌是侵袭性较小的亚组；然而，晚期CA19-9正常的胰腺癌对基于吉西他滨的化疗反应较差。
