Chen Qichen, Zheng Yiling, Zhao Hong, Cai Jianqiang, Wang Liming, Zhao Jianjun, Bi Xinyu, Li Zhiyu, Huang Zhen, Zhang Yefan, Zhou Jianguo, Wu Jianxiong
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Ann Transl Med. 2020 Mar;8(5):192. doi: 10.21037/atm.2020.01.72.
To investigate the predictive role of D-dimer and its combination of preoperative CA19-9 for lymph node metastasis (LNM) and prognosis in intrahepatic cholangiocarcinoma (ICC) patients who underwent curative-intent resection.
One hundred and seventy-three patients admitted to our hospital between April 2012 and December 2018 were included. The combination of preoperative D-dimer and CA19-9 (CPDC) was scored as 0 (decreased D-dimer levels with decreased CA19-9 levels), 2 (elevated D-dimer levels with elevated CA19-9 levels), or 1 (all other combinations). Multivariate logistic regression analysis was performed to identify independent factors. Cox proportional hazard regression was adopted for the multivariate survival analysis.
The CPDC score was an independent predictor of LNM and overall survival (OS) in the multivariate analyses. For the prediction of LNM, the area under the curve (AUC) for the CPDC score was 0.722 (95% CI: 0.613-0.831, P<0.001), and for the prediction of survival, the AUC for the CPDC score was 0.756 (95% CI: 0.658-0.854, P<0.001). The predictive capacity of the CPDC score was higher than that of D-dimer or CA19-9. Kaplan-Meier curve analysis revealed that a CPDC =2 was significantly associated with a worse OS (P<0.001, median OS: 8.00 versus 19.00 months versus not reached) and shorter progression-free survival (PFS) (P<0.001, median PFS: 4.00 versus 11.00 versus 15.00 months) than a CPDC =1 or CPDC =0 in ICC patients. There were significant differences in the OS comparisons between any two groups. Decreased preoperative CPDC was associated with worse OS and PFS in all subgroups except in the HBsAg (+) group. In the cirrhosis, HBsAg (-) and tumour size ≥5 cm subgroups, there were significant differences in the OS and PFS comparisons between any two groups.
The preoperative CPDC score is a convenient and powerful prognostic biomarker to predict LNM and OS for ICC patients after curative resection. Especially for radiologically-negative metastatic lymph node in ICC patients, CPDC could be helpful to assess the extent of lymph node dissection and make follow-up plans.
探讨D-二聚体及其与术前CA19-9联合检测对接受根治性切除的肝内胆管癌（ICC）患者淋巴结转移（LNM）及预后的预测作用。
纳入2012年4月至2018年12月在我院收治的173例患者。术前D-二聚体与CA19-9联合检测结果（CPDC）分为0分（D-二聚体水平降低且CA19-9水平降低）、2分（D-二聚体水平升高且CA19-9水平升高）或1分（其他所有组合）。进行多因素logistic回归分析以确定独立因素。采用Cox比例风险回归进行多因素生存分析。
在多因素分析中，CPDC评分是LNM和总生存（OS）的独立预测因素。对于LNM的预测，CPDC评分的曲线下面积（AUC）为0.722（95%CI：0.613-0.831，P<0.001）；对于生存的预测，CPDC评分的AUC为0.756（95%CI：0.658-0.854，P<0.001）。CPDC评分的预测能力高于D-二聚体或CA19-9。Kaplan-Meier曲线分析显示，与CPDC =1或CPDC =0的ICC患者相比，CPDC =2的患者OS显著更差（P<0.001，中位OS：8.00个月对19.00个月对未达到），无进展生存期（PFS）更短（P<0.001，中位PFS：4.00个月对11.00个月对15.00个月）。任意两组之间的OS比较均有显著差异。除HBsAg(+)组外，术前CPDC降低与所有亚组的OS和PFS较差相关。在肝硬化、HBsAg(-)和肿瘤大小≥5 cm亚组中，任意两组之间的OS和PFS比较均有显著差异。
术前CPDC评分是预测ICC患者根治性切除后LNM和OS的便捷且有力的预后生物标志物。特别是对于ICC患者影像学检查阴性的转移性淋巴结，CPDC有助于评估淋巴结清扫范围并制定随访计划。
