Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-Ku, Kumamoto, 860-0811, Japan.
BMC Surg. 2022 Oct 28;22(1):367. doi: 10.1186/s12893-022-01825-3.
Postoperative pancreatic fistula (POPF) is a critical complication of pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC). Recent papers reported that serum carbohydrate antigen (CA)19-9 levels predicted long-term prognosis. We investigated whether preoperative serum CA19-9 levels were associated with POPF in PDAC patients.
This cohort study was conducted at a single institution retrospectively. Clinicopathologic features were determined using medical records.
Among of 196 consecutive patients who underwent pancreatectomy against PDAC, 180 patients whose CA19-9 levels were above the measurement sensitivity, were registered in this study. The patients consisted of 122 patients who underwent pancreaticoduodenectomy and 58 patients who underwent distal pancreatectomy. Several clinicopathological factors, including CA 19-9 level, as well as surgical factors were determined retrospectively based on the medical records. Patients with high CA19-9 levels had a significantly higher incidence of POPF than those with low levels (43.9 vs. 13.0%, P < 0.0001). The receiver operating characteristic curves calculated that the cutoff CA19-9 value to predict POPF was 428 U/mL. CA19-9, BMI, curability, and histology were statistically significant risk factors for POPF by univariate analysis. Multivariate analysis showed that CA19-9 and BMI levels were statistically significant independent risk factors for POPF. CA19-9 levels were correlated with both histology and curability. Disease free survival and overall survival of patients with higher levels of CA19-9 were significantly shorter than that of patients with lower levels of preoperative serum CA19-9.
In patients undergoing pancreatectomy for PDAC, higher preoperative CA19-9 levels are a significant predictor for POPF.
术后胰腺瘘（POPF）是胰腺导管腺癌（PDAC）患者胰腺切除术后的一种严重并发症。近期文献报道，血清碳水化合物抗原（CA）19-9 水平可预测长期预后。我们研究了 PDAC 患者术前血清 CA19-9 水平是否与 POPF 相关。
本队列研究为单中心回顾性研究。使用病历确定临床病理特征。
在 196 例连续接受胰腺切除术治疗 PDAC 的患者中，有 180 例患者的 CA19-9 水平超过检测灵敏度，被纳入本研究。这些患者包括 122 例行胰十二指肠切除术和 58 例行胰体尾切除术的患者。根据病历，回顾性确定了包括 CA 19-9 水平在内的多个临床病理因素以及手术因素。CA19-9 水平较高的患者发生 POPF 的发生率显著高于 CA19-9 水平较低的患者（43.9% vs. 13.0%，P < 0.0001）。计算得出的受试者工作特征曲线表明，预测 POPF 的截断 CA19-9 值为 428 U/mL。CA19-9、BMI、可治愈性和组织学是通过单因素分析预测 POPF 的统计学显著危险因素。多因素分析显示，CA19-9 和 BMI 水平是预测 POPF 的统计学显著独立危险因素。CA19-9 水平与组织学和可治愈性均相关。CA19-9 水平较高的患者无病生存率和总生存率明显短于 CA19-9 水平较低的患者。
在接受胰腺切除术治疗 PDAC 的患者中，较高的术前 CA19-9 水平是 POPF 的显著预测因子。
