Xi Wenfeng, Liao Wanying, Guo Tao, Jiang Qingwei, Bai Xiaoyin, Wu Xi, Feng Yunlu, Zhang Shengyu, Wu Dongsheng, Wang Qiang, Yang Aiming
Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
BMC Gastroenterol. 2025 Apr 29;25(1):306. doi: 10.1186/s12876-025-03925-9.
Pancreatic head-type autoimmune pancreatitis (PH-AIP) with elevated CA19-9 is sometimes difficult to distinguish from pancreatic head cancer (PHC) with elevated CA19-9. At times, IgG4 proves inadequate in offering assistance. The study aimed to elucidate the performance of CA19-9/DBil in distinguishing between the two conditions.
This was a retrospective study. We collected serologic indicators from participants in PH-AIP and PHC Group. Three logistic regression equations were established ranging from non-adjustment (Model 1, only CA19-9/DBil included) to adjusting for sex, age, and CEA (Model 2 and Model 3) to explore the relationship between CA19-9/DBil and PH-AIP probability. ROC, Decision Curve Analysis (DCA), calibration curve were conducted. P for AUCs and net reclassification improvements (NRI) were computed to evaluate differences in discrimination and the improvement in risk reclassification between models.
The study included 90 PHC and 35 PH-AIP patients, all with elevated CA19-9. The ORs for CA19-9/DBil in three models were similar (0.915 to 0.921). ROC revealed that Model 1 had an AUC of 0.772. The sensitivity, specificity, and accuracy at the best threshold were all > 0.7. Model 1, although simple, was not inferior in its discriminative ability compared to complex models: the difference in discrimination between Model 1 and each of two adjusted models was not statistically significant (P > 0.05, both AUC and NRI). Additionally, calibration curve and DCA suggested that Model 1 had good calibration and clinical utility.
CA19-9/DBil exhibited promising diagnostic performance in differentiating between CA19-9-elevated PH-AIP and PHC.
伴有CA19-9升高的胰头型自身免疫性胰腺炎（PH-AIP）有时难以与伴有CA19-9升高的胰头癌（PHC）相区分。有时，IgG4在提供鉴别帮助方面并不充分。本研究旨在阐明CA19-9/总胆红素（DBil）在区分这两种疾病中的表现。
这是一项回顾性研究。我们收集了PH-AIP组和PHC组参与者的血清学指标。建立了三个逻辑回归方程，从不调整（模型1，仅纳入CA19-9/DBil）到调整性别、年龄和癌胚抗原（CEA）（模型2和模型3），以探讨CA19-9/DBil与PH-AIP概率之间的关系。进行了受试者工作特征曲线（ROC）、决策曲线分析（DCA）和校准曲线分析。计算曲线下面积（AUC）的P值和净重新分类改善（NRI），以评估模型之间鉴别能力的差异和风险重新分类的改善情况。
该研究纳入了90例PHC患者和35例PH-AIP患者，所有患者的CA19-9均升高。三个模型中CA19-9/DBil的比值比（OR）相似（0.915至0.921）。ROC显示模型1的AUC为0.772。最佳阈值下的敏感性、特异性和准确性均>0.7。模型1虽然简单，但其鉴别能力与复杂模型相比并不逊色：模型1与两个调整模型中每个模型之间的鉴别差异无统计学意义（P>0.05，AUC和NRI均如此）。此外，校准曲线和DCA表明模型1具有良好的校准和临床实用性。
CA19-9/DBil在区分CA19-9升高的PH-AIP和PHC方面表现出良好的诊断性能。
