Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
World J Surg Oncol. 2023 Jan 18;21(1):13. doi: 10.1186/s12957-023-02903-3.
The finding that some benign pancreatic masses mimic the imaging appearance of carcinomas poses a challenge for pancreatic surgeons. Preoperative markers that assist in the diagnosis are critical under this circumstance. Abnormal serum creatine kinase (CK) isozyme levels were reported in cancer patients, and this study aimed to explore the potential value of the CK-MB-to-total-CK ratio (CK ratio) in differentiating pancreatic cancer (PC) from benign masses when combined with carbohydrate antigen 19-9 (CA19-9).
A total of 190 patients primarily diagnosed with pancreatic masses were retrospectively reviewed and assigned to the PC group and the benign pancreatic mass (BPM) group. Sixty-eight controls were enrolled for comparison. Levels of preoperative parameters, including total serum CK, CK-MB, absolute neutrophil count, absolute lymphocyte count, albumin, and CA19-9, were recorded as well as pathological information. A logistic regression model was established to assess the application value of the combination of CA19-9 and the CK ratio in diagnosis. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of the markers.
The CK ratio was significantly elevated in the PC group compared with the BPM group (P < 0.001). In the multivariate analysis, a CK ratio greater than 0.220 was a statistically significant variable for predicting malignancy of pancreatic masses (P=0.001). Patients with stage III/IV PC had a higher CK ratio than those with stage I/II PC (P<0.01). Combined detection of CA19-9 and the CK ratio produced an increased Youden index (0.739 vs. 0.815) with improved sensitivity (82.2% vs. 89.8%).
The CK ratio is elevated in patients with pancreatic adenocarcinoma and is an independent factor predicting pancreatic adenocarcinoma. The CK ratio augments the diagnostic capacity of CA19-9 in detecting malignancy.
一些良性胰腺肿块的影像学表现类似于癌，这给胰腺外科医生带来了挑战。在这种情况下，术前有助于诊断的标志物至关重要。有报道称癌症患者的血清肌酸激酶（CK）同工酶水平异常，本研究旨在探讨 CK-MB 与总 CK 比值（CK 比值）与糖链抗原 19-9（CA19-9）联合应用于鉴别胰腺癌（PC）与良性肿块时的潜在价值。
回顾性分析了 190 例主要诊断为胰腺肿块的患者，将其分为 PC 组和良性胰腺肿块（BPM）组，并纳入 68 例对照。记录术前总血清 CK、CK-MB、中性粒细胞绝对值、淋巴细胞绝对值、白蛋白和 CA19-9 等参数水平及病理信息。建立 logistic 回归模型评估 CA19-9 和 CK 比值联合诊断的应用价值。构建受试者工作特征（ROC）曲线评估标志物的诊断价值。
PC 组 CK 比值明显高于 BPM 组（P<0.001）。多变量分析显示，CK 比值大于 0.220 是预测胰腺肿块恶性程度的统计学显著变量（P=0.001）。Ⅲ/Ⅳ期 PC 患者的 CK 比值高于Ⅰ/Ⅱ期 PC 患者（P<0.01）。CA19-9 和 CK 比值联合检测的 Youden 指数增加（0.739 比 0.815），灵敏度提高（82.2%比 89.8%）。
胰腺腺癌患者 CK 比值升高，是预测胰腺腺癌的独立因素。CK 比值增加了 CA19-9 检测恶性肿瘤的诊断能力。
