Department of Digestive Surgical Oncology, University Hospital of Dijon, France.
Department of Digestive Surgical Oncology, University Hospital of Dijon, France; INSERM Unit 866, Dijon, France.
Pancreatology. 2018 Sep;18(6):666-670. doi: 10.1016/j.pan.2018.07.001. Epub 2018 Jul 3.
Surgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia.
To evaluate CA 19-9 serum levels as a predictor of unresectability of pancreatic adenocarcinomas with a special focus on jaundiced patients.
All patients presenting with histologically-confirmed pancreatic adenocarcinoma and having serum CA 19-9 levels available prior to any treatment were included in this retrospective study. The relationship between serum concentrations of CA 19-9 and resectability was studied by regression analysis and theROC curves obtained. A cut-off value of CA 19-9 was calculated. In jaundiced patients, a CA 19-9 adjusted for bilirubinemia was also evaluated.
Of the 171 patients included, 49 (29%) were deemed resectable and 122 (71%) unresectable. Altogether, 93 patients (54%) had jaundice. The area under the ROC curve for CA 19-9 as a predictor of resectability was 0.886 (95%CI:[0.832-0.932]); in jaundiced patients it was 0.880 (95% CI [0.798-0.934]. A cut-off in CA 19-9 at 178 UI/mlyielded 85% sensitivity, 81% specificity and 91% positive predictive value for resectability. There was no correlation between the levels of bilirubin and CA 19-9 (r = 0.149).
Serum CA 19-9 is a good predictive marker of unresectability of pancreatic adenocarcinoma, even in jaundiced patients. CA 19-9 levels over 178 UI/ml strongly suggest unresectable disease.
手术切除仍然是治疗胰腺腺癌的唯一方法。尽管近年来医学影像学有了进步，但在手术时仍经常发现无法切除。术前识别无法切除的患者至关重要，以避免不必要的手术。血清 CA 19-9 水平升高已被认为是不可切除的标志物，但在高胆红素血症患者中认为不准确。
评估血清 CA 19-9 水平作为胰腺腺癌不可切除性的预测指标，特别关注黄疸患者。
本回顾性研究纳入了所有组织学证实的胰腺腺癌患者，这些患者在任何治疗前均有血清 CA 19-9 水平。通过回归分析和获得的 ROC 曲线研究血清 CA 19-9 浓度与可切除性之间的关系。计算 CA 19-9 的截断值。在黄疸患者中，还评估了胆红素校正后的 CA 19-9。
在纳入的 171 名患者中，49 名（29%）被认为可切除，122 名（71%）不可切除。共有 93 名患者（54%）有黄疸。CA 19-9 作为可切除性预测指标的 ROC 曲线下面积为 0.886（95%CI：[0.832-0.932]）；在黄疸患者中为 0.880（95%CI [0.798-0.934]）。CA 19-9 截断值为 178 UI/ml 时，对可切除性的敏感性为 85%，特异性为 81%，阳性预测值为 91%。胆红素和 CA 19-9 之间没有相关性（r=0.149）。
血清 CA 19-9 是胰腺腺癌不可切除性的良好预测标志物，即使在黄疸患者中也是如此。CA 19-9 水平高于 178 UI/ml 强烈提示不可切除疾病。
