Screening for pancreatic cancer in a high-risk population with serum CA 19-9 and targeted EUS: a feasibility study
Screening for pancreatic cancer in a high-risk population with serum CA 19-9 and targeted EUS: a feasibility study
复制标题
DOI：
10.1016/j.gie.2011.03.1235
复制
发表时间：
2011-07-01
影响因子：
7.7
通讯作者：
Vecchio, James
中科院分区：
文献类型：
--
作者：
Zubarik, Richard;Gordon, Stuart R.;Vecchio, James
背景资料：胰腺癌的早期检测是必要的。目的：为了确定是否可以通过使用CA 19-9随后靶向EUS在高危人群中检测到早期胰腺肿瘤。设计：前瞻性队列研究。设置：两个学术医疗中心。患者：符合条件的患者符合年龄标准，并且至少有一个一级亲属患有胰腺癌。干预措施：对所有患者进行血清CA 119-9检测。如果CA 19-9水平升高，则进行EUS。对确定的病变进行FNA。将使用该筛选方案检测到的胰腺癌患者与存在分期数据的方案外患者进行比较。医疗保险报销率用于获得成本data.Main结果测量：早期胰腺肿瘤的检测。27例患者CA 19-9升高（4.9%，95% CI，3.2%-7.1%）。5例患者（0.9%，95% CI，0.3%-2.1%）检测到肿瘤或恶性结果，1例患者（0.2%，95% CI，0.005%-4.02%）检测到胰腺癌。作为本方案的一部分检测到的胰腺癌患者是佛蒙特大学2例1期癌症患者中的1例。检测1例胰腺肿瘤的成本为8431美元。检测1例胰腺癌的成本为$41，133.Limitations：样本量仅足以证明此方法的可行性。结论：此筛选方案可确定潜在治愈性胰腺癌。阶段它胰腺癌是更有可能通过使用这种筛查方案比通过使用标准的检测手段被检测到。（Gastrointest Enclose 2011;74：87-95.）
Background: Earlier detection of pancreatic adenocarcinoma is needed.Objective: To determine whether early pancreatic neoplasia can be detected in a high-risk population by using CA 19-9 followed by targeted EUS.Design: Prospective cohort study.Setting: Two academic medical centers.Patients: Eligible patients met age criteria and had at least 1 first-degree relative with pancreatic adenocarcinoma.Interventions: A serum CA 119-9 was performed on all patients. EUS was performed if the CA 19-9 level was elevated. FNA of identified lesions was performed. Patients with pancreatic cancer detected by using this screening protocol were compared with patients presenting off-protocol for staging data. Medicare reimbursement rates were used to derive cost data.Main Outcome Measurements: Detection of early pancreatic neoplasia.Results: A total of 546 patients were enrolled. CA 19-9 was elevated in 27 patients (4.9%, 95% CI, 3.2%-7.1%). Neoplastic or malignant Findings were detected in 5 patients (0.9%, 95% CI, 0.3%-2.1%), and pancreatic adenocarcinoma in 1 patient (0.2%, 95% CI, 0.005%-4.02%). The patient with pancreatic cancer detected as part of this protocol was 1 of 2 patients presenting to the University of Vermont with stage 1 cancer. The cost to detect 1 pancreatic neoplasia was $8431. The cost to detect 1 pancreatic adenocarcinoma was $41,133.Limitations: The sample size is adequate only to demonstrate the feasibility of this approach.Conclusions: Potentially curative pancreatic adenocarcinoma can be identified with this screening protocol. Stage It pancreatic cancer is more likely to be detected by using this screening protocol than by using standard means of detection. (Gastrointest Enclose 2011;74:87-95.)