回顾性评估 CT 和 CA 19-9 对非转移性胰腺癌患者的治疗反应。
Retrospective Evaluation of Treatment Response in Patients with Nonmetastatic Pancreatic Cancer Using CT and CA 19-9.
机构信息
From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea (S.S.K., S.L., M.S.P.); Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (H.S.L., S.B.); and Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Republic of Korea (K.H.).
出版信息
Radiology. 2022 Jun;303(3):548-556. doi: 10.1148/radiol.212236. Epub 2022 Mar 8.
Background Imaging studies have limitations in evaluating pancreatic ductal adenocarcinoma (PDAC) treatment response. Purpose To investigate the effectiveness of combined CT and carbohydrate antigen 19-9 (CA 19-9) evaluation at 8 weeks after first-line treatment to predict overall survival (OS) of patients with nonmetastatic PDAC. Materials and Methods Patients with nonmetastatic PDAC who received first-line treatment with either chemotherapy or concurrent chemoradiation in a single-center PDAC cohort registry were retrospectively enrolled in the study between January 2013 and December 2016. Follow-up CT images obtained 8 weeks after treatment were evaluated according to Response Evaluation Criteria in Solid Tumors. Patients with partial response (PR) or stable disease (SD) were defined as CT responders, and those with progressive disease (PD) were defined as CT nonresponders. Patients with a normalized CA 19-9 level at 8-week follow-up were defined as CA 19-9 responders, and those with a nonnormalized or nonelevated CA 19-9 level were defined as CA 19-9 nonresponders. OS was compared using the Kaplan-Meier method with Breslow analysis. Results A total of 197 patients (mean age ± standard deviation, 65 years ± 10; 107 men) were evaluated. Patients with PD ( = 17) showed shorter OS than those with SD ( = 147; < .001) or PR ( = 33; = .003). OS did not differ between the patients with PR and those with SD ( = .60). When the CT and CA 19-9 responses were integrated, OS was longest in CT and CA 19-9 responders (group 1, = 27; median OS, 26.6 months [95% CI: 9.0, 44.1]), followed by CT responders but CA 19-9 nonresponders (group 2, = 153; median OS, 15.9 months [95% CI: 13.3, 18.5]; = .007 vs group 1) and CT and CA 19-9 nonresponders (group 3, = 17; median OS, 6.5 months [95% CI: 0.8, 12.2]; < .001 vs group 2). Conclusion Integrated evaluation with CT and carbohydrate antigen 19-9 response allowed more accurate stratification of survival in patients with pancreatic ductal adenocarcinoma in the early treatment period than did evaluation according to Response Evaluation Criteria in Solid Tumors. © RSNA, 2022
背景 成像研究在评估胰腺导管腺癌 (PDAC) 治疗反应方面存在局限性。目的 研究在一线治疗后 8 周时联合 CT 和肿瘤标志物碳水化合物抗原 19-9 (CA 19-9) 评估对预测无转移 PDAC 患者总生存期 (OS) 的有效性。材料与方法 回顾性分析 2013 年 1 月至 2016 年 12 月期间在单中心 PDAC 队列登记处接受一线化疗或同期放化疗的非转移性 PDAC 患者，纳入本研究。根据实体瘤反应评估标准对治疗后 8 周的随访 CT 图像进行评估。部分缓解 (PR) 或疾病稳定 (SD) 的患者定义为 CT 缓解者，疾病进展 (PD) 的患者定义为 CT 无缓解者。CA 19-9 水平在 8 周随访时正常的患者定义为 CA 19-9 缓解者，CA 19-9 水平未正常或未升高的患者定义为 CA 19-9 无缓解者。使用 Breslow 分析的 Kaplan-Meier 方法比较 OS。结果 共评估了 197 例患者（平均年龄 ± 标准差，65 岁 ± 10 岁；107 例男性）。PD 患者（ = 17）的 OS 明显短于 SD 患者（ = 147； ＜.001）或 PR 患者（ = 33； =.003）。PR 患者与 SD 患者的 OS 无差异（ =.60）。当整合 CT 和 CA 19-9 反应时，CT 和 CA 19-9 缓解者（ = 27；中位 OS，26.6 个月 [95%CI：9.0，44.1]）的 OS 最长，其次是 CT 缓解但 CA 19-9 无缓解者（ = 153；中位 OS，15.9 个月 [95%CI：13.3，18.5]； =.007 与组 1）和 CT 和 CA 19-9 无缓解者（ = 17；中位 OS，6.5 个月 [95%CI：0.8，12.2]； ＜.001 与组 2）。结论 与根据实体瘤反应评估标准进行评估相比，在早期治疗期间，通过 CT 和 CA 19-9 反应的综合评估可以更准确地分层胰腺导管腺癌患者的生存情况。
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