Motoi Fuyuhiko, Murakami Yoshiaki, Okada Ken-Ichi, Matsumoto Ippei, Uemura Kenichiro, Satoi Sohei, Sho Masayuki, Honda Goro, Fukumoto Takumi, Yanagimoto Hiroaki, Kinoshita Shoichi, Kurata Masanao, Aoki Shuichi, Mizuma Masamichi, Yamaue Hiroki, Unno Michiaki
Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
World J Surg. 2019 Feb;43(2):634-641. doi: 10.1007/s00268-018-4814-4.
Survival after surgery for pancreatic adenocarcinoma (PA) is poor and heterogeneous, even for curative (R0) resection. Serum carbohydrate antigen (CA) 19-9 levels are important prognostic markers for resected PA. However, sustained elevation of CA19-9 in association with the patterns of recurrence has been rarely investigated.
Patients who underwent R0 resection (n = 539) were grouped according to postoperative serum CA19-9 levels (Group E: sustained elevation; Group N: no elevation). Clinicopathological factors, patterns of recurrence, and survival were compared between the groups.
Group E (n = 159) had significantly shorter median overall survival (17.1 vs. 35.4 months, p < 0.0001) than Group N (n = 380). Postoperative CA19-9 elevation was a significant independent predictor of poor survival in multivariate analysis (hazard ratio 1.98, p < 0.0001). The rate of hepatic recurrence in Group E was 2.6-fold higher than in Group N (45% vs. 17%, p < 0.0001). Postoperative CA19-9 elevation was a strongest independent predictor of primary hepatic recurrence (p < 0.0001) by a multiple regression model. Loco-regional, peritoneal, and other distant recurrence did not differ between the groups. The extent of preoperative CA19-9 elevation was correlated sustained elevation of CA19-9 after surgery (p < 0.0001) and primary hepatic recurrence (p = 0.0019).
Sustained CA19-9 elevation was strong predictor of primary hepatic recurrence and short survival in cases of R0 resection for PA.
胰腺腺癌（PA）手术后的生存率较低且存在异质性，即使是根治性（R0）切除也是如此。血清糖类抗原（CA）19-9水平是切除术后PA的重要预后标志物。然而，CA19-9持续升高与复发模式之间的关系鲜有研究。
对接受R0切除的患者（n = 539）根据术后血清CA19-9水平进行分组（E组：持续升高；N组：未升高）。比较两组的临床病理因素、复发模式和生存率。
E组（n = 159）的中位总生存期明显短于N组（n = 380）（17.1个月对35.4个月，p < 0.0001）。多因素分析显示，术后CA19-9升高是生存不良的显著独立预测因素（风险比1.98，p < 0.0001）。E组肝复发率比N组高2.6倍（45%对17%，p < 0.0001）。多因素回归模型显示，术后CA19-9升高是原发性肝复发的最强独立预测因素（p < 0.0001）。两组在局部区域、腹膜和其他远处复发方面无差异。术前CA19-9升高程度与术后CA19-9持续升高（p < 0.0001）及原发性肝复发（p = 0.0019）相关。
在PA的R0切除病例中，CA19-9持续升高是原发性肝复发和生存期短的有力预测因素。
