Murakami Mariko, Nagai Yoshio, Tenjin Ayumi, Tanaka Yasushi
Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan.
Endocr J. 2018 Jun 27;65(6):639-643. doi: 10.1507/endocrj.EJ17-0380. Epub 2018 Apr 11.
Pancreatic cancer is a highly lethal malignancy. CA19-9 is a well-known marker for diagnosis of pancreatic cancer, but the serum CA19-9 level is reported to be elevated in patients with poorly controlled diabetes. This study evaluated the sensitivity, specificity, and cut-off value of serum CA19-9 for detection of pancreatic cancer in patients with diabetes. A case-control study of 236 patients was performed. The case group was selected from diabetic patients with pancreatic cancer, while one control was selected for each case from among diabetic patients without pancreatic cancer during the same period. The case group (n = 118) and the control group (n = 118) were matched for age, sex, and pancreatic cancer risk factors. Receiver operating characteristic (ROC) curves were plotted to determine the serum CA19-9 level that predicted pancreatic cancer. Then the sensitivity and specificity of CA19-9 were calculated for the threshold value. There were no significant differences of age, sex, BMI, smoking, alcohol intake, and HbA1c between the case and control groups. According to ROC analysis, a serum CA19-9 level of 75 U/mL had the maximum sensitivity and specificity for separating diabetic patients with or without pancreatic cancer. Using this cut-off value, the sensitivity and specificity of CA19-9 for pancreatic cancer was 69.5% and 98.2%, respectively, while the area under the ROC curve was 0.875 [95%CI: 0.826-0.924]. We propose that a serum CA19-9 level of 75 U/mL should be used as the cut-off value when screening patients with diabetes for pancreatic cancer.
胰腺癌是一种高度致命的恶性肿瘤。CA19-9是诊断胰腺癌的一种知名标志物，但据报道，血糖控制不佳的患者血清CA19-9水平会升高。本研究评估了血清CA19-9在糖尿病患者中检测胰腺癌的敏感性、特异性和临界值。对236例患者进行了病例对照研究。病例组选自患有胰腺癌的糖尿病患者，而对照组则从同期未患胰腺癌的糖尿病患者中为每个病例选取1名对照。病例组（n = 118）和对照组（n = 118）在年龄、性别和胰腺癌危险因素方面进行了匹配。绘制受试者工作特征（ROC）曲线以确定预测胰腺癌的血清CA19-9水平。然后计算CA19-9在该阈值下的敏感性和特异性。病例组和对照组在年龄、性别、体重指数、吸烟、饮酒和糖化血红蛋白方面无显著差异。根据ROC分析，血清CA19-9水平为75 U/mL时，区分患有或未患有胰腺癌的糖尿病患者具有最高的敏感性和特异性。使用该临界值时，CA19-9对胰腺癌的敏感性和特异性分别为69.5%和98.2%，而ROC曲线下面积为0.875 [95%CI：0.826 - 0.924]。我们建议，在对糖尿病患者进行胰腺癌筛查时，应将血清CA19-9水平75 U/mL用作临界值。
