Lyu Shao-Cheng, Wang Jing, Huang Mengxiu, Wang Han-Xuan, Zhou Lin, He Qiang, Lang Ren
Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
Cancer Manag Res. 2021 Jun 21;13:4887-4898. doi: 10.2147/CMAR.S313517. eCollection 2021.
The aim of this study was to reduce the influence of biliary obstruction on carbohydrate antigen 19-9 level (CA19-9) by introducing the CA19-9 level to serum γ-glutamyltransferase (GGT) ratio as an indicator, and ultimately to reveal the correlation between CA19-9/GGT and the prognosis of patients with pancreatic head carcinoma (PHC).
A total of 339 enrolled patients who underwent pancreatoduodenectomy for PHC in Beijing ChaoYang Hospital from January 2010 to December 2019 were analyzed retrospectively. The optimal cut-off value, according to which patients were divided into a low-ratio group (Group 1, n=179) and a high-ratio group (Group 2, n=160), was determined by the ROC curve obtained from preoperative CA19-9/GGT and 1-year survival. Through univariate and multivariate analyses, risk factors for postoperative tumor recurrence and long-term survival were screened out among PHC patients.
The best cut-off value of CA19-9/GGT was 2.07 (area under the curve=0.567, 95% CI 0.498-0.636). Compared with Group 2, Group 1 had lower CA19-9, and higher GGT, total bilirubin (TB) and lymph-node metastasis rate (<0.05). The 1-, 2- and 3-year disease-free survival rates of patients in Groups 1 and 2 were 68.2%, 42.5% and 28.2%, and 42.2%, 19.3% and 18.3%, respectively (=0.000), and the 1-, 2- and 3-year overall survival rates were 79.1%, 50.7% and 29.1%, and 56.7%, 22.2% and 17.2%, respectively (=0.000). Multivariate analysis showed that CA19-9/GGT, portal system invasion and lymph-node metastasis were independent risk factors for postoperative tumor recurrence and long-term survival among patients with PHC.
Compared with CA19-9 level alone, CA19-9/GGT plays a more precise role in the evaluation of postoperative tumor recurrence and the long-term prognosis of PHC patients. The lower the ratio, the better the long-term prognosis. The CA19-9/GGT ratio may prove to be a useful biomarker for identifying PHC patients at high risk of early recurrence and unfavorable prognosis.
本研究旨在通过引入血清γ-谷氨酰转移酶（GGT）与糖类抗原19-9（CA19-9）水平的比值作为指标，降低胆道梗阻对CA19-9水平的影响，并最终揭示CA19-9/GGT与胰头癌（PHC）患者预后之间的相关性。
回顾性分析2010年1月至2019年12月在北京朝阳医院接受胰十二指肠切除术治疗PHC的339例入组患者。根据术前CA19-9/GGT与1年生存率的ROC曲线确定最佳截断值，据此将患者分为低比值组（第1组，n = 179）和高比值组（第2组，n = 160）。通过单因素和多因素分析，筛选出PHC患者术后肿瘤复发和长期生存的危险因素。
CA19-9/GGT的最佳截断值为2.07（曲线下面积 = 0.567，95% CI 0.498 - 0.636）。与第2组相比，第1组的CA19-9水平较低，GGT、总胆红素（TB）水平及淋巴结转移率较高（P < 0.05）。第1组和第2组患者的1年、2年和3年无病生存率分别为68.2%、42.5%和28.2%，以及42.2%、19.3%和18.3%（P = 0.000），1年、2年和3年总生存率分别为79.1%、50.7%和29.1%，以及56.7%、22.2%和17.2%（P = 0.000）。多因素分析显示，CA19-9/GGT、门静脉系统侵犯和淋巴结转移是PHC患者术后肿瘤复发和长期生存的独立危险因素。
与单独的CA19-9水平相比，CA19-9/GGT在评估PHC患者术后肿瘤复发和长期预后方面发挥着更精确的作用。比值越低，长期预后越好。CA19-9/GGT比值可能是识别早期复发和预后不良高风险PHC患者的有用生物标志物。
