糖链抗原 19-9 应答与肝内胆管癌放射学应答和生存的相关性：一项前瞻性队列研究。
The association of carbohydrate antigen 19-9 response with radiologic response and survival in intrahepatic cholangiocarcinoma: A prospective cohort study.
机构信息
Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University, Shanghai, China.
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University, Shanghai, China.
出版信息
Cancer. 2023 Oct 1;129(19):2999-3009. doi: 10.1002/cncr.34854. Epub 2023 Jul 14.
BACKGROUND
The role of carbohydrate antigen 19-9 (CA 19-9) in response assessment among patients with intrahepatic cholangiocarcinoma (iCCA) remains unknown. The authors studied the association of the CA 19-9 response (defined as a reduction >50% from baseline) with the radiologic response and the outcome in patients with unresectable iCCA.
METHODS
A prospective cohort of 422 patients who were initially diagnosed with unresectable iCCA, had baseline CA 19-9 levels ≥100 U/mL, and received treatment with systemic therapies at the authors' institution between January 2017 and December 2021 were enrolled in this study. The radiologic response was assessed using the Response Evaluation Criteria in Solid Tumors version 1.1. A landmark assessment of the CA 19-9 response and the radiologic response was performed. The associations between CA 19-9 response and imaging response, progression-free survival (PFS), and overall survival (OS) were analyzed.
RESULTS
Two hundred sixty-seven patients (63.3%) had a CA 19-9 response. A CA 19-9 response was observed in 123 of 132 (93.2%) radiologic responders and in 144 of 290 (49.7%) radiologic nonresponders (p < .001). CA 19-9 responders outperformed nonresponders in median PFS (10.6 vs. 3.6 months; hazard ratio [HR], 4.8 months; 95% confidence interval [CI], 3.8-6.0 months; p < .001) and OS (21.4 vs. 6.3 months; HR, 5.3 months; 95% CI, 4.2-6.7 months; p < .001). The common independent predictors of both OS and PFS included metastasis, CA 19-9 nonresponder status, and radiologic nonresponder status in multivariable analysis.
CONCLUSIONS
CA 19-9 response is a valuable addition to assess tumor response and is associated with improved outcomes in patients with iCCA. Achieving a CA 19-9 response should be one of the therapeutic objectives of patients with iCCA after systemic therapies.
PLAIN LANGUAGE SUMMARY
A decline in carbohydrate antigen 19-9 levels from elevated baseline levels should be one of the therapeutic aims of patients with intrahepatic cholangiocarcinoma who are managed with systemic therapies.
背景
肿瘤标志物癌抗原 19-9（CA 19-9）在评估肝内胆管癌（iCCA）患者的疗效中的作用尚不清楚。作者研究了 CA 19-9 应答（定义为基线时降低>50%）与不可切除 iCCA 患者的影像学应答和结局之间的相关性。
方法
本研究纳入了 2017 年 1 月至 2021 年 12 月在作者所在机构接受系统治疗的 422 例最初诊断为不可切除 iCCA、基线 CA 19-9 水平≥100 U/mL 的患者。使用实体瘤反应评估标准 1.1 评估影像学应答。对 CA 19-9 应答和影像学应答进行了里程碑式评估。分析了 CA 19-9 应答与影像学应答、无进展生存期（PFS）和总生存期（OS）之间的相关性。
结果
267 例患者（63.3%）CA 19-9 应答。132 例影像学应答者中有 123 例（93.2%）和 290 例影像学无应答者中有 144 例（49.7%）观察到 CA 19-9 应答（p<0.001）。与无应答者相比，CA 19-9 应答者的中位 PFS（10.6 个月 vs. 3.6 个月；风险比 [HR]，4.8 个月；95%置信区间 [CI]，3.8-6.0 个月；p<0.001）和 OS（21.4 个月 vs. 6.3 个月；HR，5.3 个月；95%CI，4.2-6.7 个月；p<0.001）均更长。多变量分析显示，OS 和 PFS 的共同独立预测因素包括转移、CA 19-9 无应答状态和影像学无应答状态。
结论
CA 19-9 应答是评估肿瘤应答的一个有价值的补充指标，与 iCCA 患者的治疗结果改善相关。在接受系统治疗后，CA 19-9 应答的降低应成为 iCCA 患者的治疗目标之一。
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