Fisher A, Theise N D, Min A, Mor E, Emre S, Pearl A, Schwartz M E, Miller C M, Sheiner P A
Department of Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.
Liver Transpl Surg. 1995 Mar;1(2):94-8. doi: 10.1002/lt.500010204.
The results of liver transplantation in patients with cholangiocarcinoma have been poor. It has been suggested that elevated serum CA19-9 levels predict cholangiocarcinoma in patients with primary sclerosing cholangitis. We analyzed the predictive value of CA19-9 antigen as a marker of cholangiocarcinoma in patients with primary sclerosing cholangitis evaluated for liver transplantation. We reviewed the charts of 26 patients with primary sclerosing cholangitis (stage IV) in whom preoperative serum CA19-9 levels were determined; 22 of 26 underwent liver transplant. Explant specimens were serially sectioned and examined for tumor. In 3 of the 26 patients, cholangiocarcinoma was diagnosed during pretransplantation evaluation; exploratory laparotomy on the last patient showed no evidence of cholangiocarcinoma, and this patient is awaiting transplantation. Twelve of the 26 patients had CA19-9 levels more than double the laboratory reference range (0-37 U/mL) (mean 183.1 +/- 103 U/mL, range 77-415 U/mL). Two of the 12 patients with elevated CA19-9 levels had cholangiocarcinoma. Of the 14 patients with normal levels, two had cholangiocarcinoma. No correlation between elevated CA19-9 and bile duct dysplasia was noted. Sensitivity for serum CA19-9 levels more than twice the reference range is 50%, specificity is 54.5%, positive predictive value is 16.6%. An elevated serum CA19-9 level in a patient with stage IV primary sclerosing cholangitis does not reliably predict coexisting cholangiocarcinoma. Persistently high or rising serum CA19-9 levels do not indicate more urgent need for liver transplantation.
胆管癌患者肝移植的结果一直不佳。有人提出，血清CA19-9水平升高可预测原发性硬化性胆管炎患者是否患有胆管癌。我们分析了CA19-9抗原作为胆管癌标志物在接受肝移植评估的原发性硬化性胆管炎患者中的预测价值。我们回顾了26例原发性硬化性胆管炎（IV期）患者的病历，这些患者术前测定了血清CA19-9水平；26例中有22例接受了肝移植。对切除的标本进行连续切片并检查是否有肿瘤。26例患者中有3例在移植前评估期间被诊断为胆管癌；最后1例患者的探查性剖腹手术未发现胆管癌证据，该患者正在等待移植。26例患者中有12例的CA19-9水平超过实验室参考范围（0-37 U/mL）的两倍（平均183.1±103 U/mL，范围77-415 U/mL）。CA19-9水平升高的12例患者中有2例患有胆管癌。在CA19-9水平正常的14例患者中，有2例患有胆管癌。未发现CA19-9升高与胆管发育异常之间存在相关性。血清CA19-9水平超过参考范围两倍以上时的敏感性为50%，特异性为54.5%，阳性预测值为16.6%。IV期原发性硬化性胆管炎患者血清CA19-9水平升高并不能可靠地预测是否并存胆管癌。血清CA19-9水平持续升高或上升并不表明更迫切需要进行肝移植。
