Liu Fei, Wang Jun-Ke, Ma Wen-Jie, Yang Qin, Hu Hai-Jie, Li Fu-Yu
Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
ANZ J Surg. 2019 Mar;89(3):E76-E80. doi: 10.1111/ans.14893. Epub 2018 Oct 10.
This study evaluated the predictive ability of preoperative carbohydrate antigen 19-9 (CA19-9) level in assessing tumour resectability in patients with gallbladder carcinoma (GBC).
We retrospectively analysed preoperative serum levels of CA19-9 in 292 patients with potentially resectable GBC between January 2000 and March 2016 in our institution. All final diagnoses were confirmed by pathological examination. The optimal cut-off point of the CA19-9 for predicting resectability was determined by the receiver operating characteristic curve. The univariate analysis and multivariate Cox regression model were applied to assess the relationship between the parameters to resectability.
A total of 292 patients with surgical treatment were included, of whom 195 were identified as curative resection (R0 resection), 69 were classified as R1/2 resection and the remaining 28 patients were operated on with palliative surgery. The receiver operating characteristic curve analysis calculated the best CA19-9 cut-off point of 98.91 U/mL in the prediction of resectability. Meanwhile, the sensitivity, specificity, positive predictive value and negative predictive value were 76.3%, 70.8%, 85.7% and 56.5%, respectively. In the multivariate logistic regression analysis, CA19-9 >98.91 U/mL (odds ratio (OR) 6.339, 95% confidence interval (CI) 3.562-11.284, P < 0.001), tumour located on hepatic side (OR 1.787, 95% CI 1.022-3.123, P = 0.042) and advanced American Joint Committee on Cancer stage (OR 2.156, 95% CI 1.180-3.940, P = 0.013) were independent determinants of resectability in patients diagnosed as GBC.
Preoperative CA19-9 predicts resectability in patients with radiological resectable GBC. Increased preoperative CA19-9 is related to poor resectability rate.
本研究评估了术前糖类抗原19-9（CA19-9）水平在评估胆囊癌（GBC）患者肿瘤可切除性方面的预测能力。
我们回顾性分析了2000年1月至2016年3月期间在我院的292例具有潜在可切除性的GBC患者的术前血清CA19-9水平。所有最终诊断均经病理检查证实。通过受试者工作特征曲线确定预测可切除性的CA19-9最佳截断点。采用单因素分析和多因素Cox回归模型评估各参数与可切除性之间的关系。
共纳入292例行手术治疗的患者，其中195例被确定为根治性切除（R0切除），69例被分类为R1/2切除，其余28例患者接受姑息性手术。受试者工作特征曲线分析计算出预测可切除性的最佳CA19-9截断点为98.91 U/mL。同时，敏感性、特异性、阳性预测值和阴性预测值分别为76.3%、70.8%、85.7%和56.5%。在多因素逻辑回归分析中，CA19-9＞98.91 U/mL（比值比（OR）6.339，95%置信区间（CI）3.562-11.284，P＜0.001）、肿瘤位于肝侧（OR 1.787，95% CI 1.022-3.123，P = 0.042）和美国癌症联合委员会晚期分期（OR 2.156，95% CI 1.180-3.940，P = 0.013）是诊断为GBC患者可切除性的独立决定因素。
术前CA19-9可预测影像学上可切除的GBC患者的可切除性。术前CA19-9升高与可切除率低有关。
