Development of a Biomarker-Based Scoring System Predicting Early Recurrence of Resectable Pancreatic Duct Adenocarcinoma.
Development of a Biomarker-Based Scoring System Predicting Early Recurrence of Resectable Pancreatic Duct Adenocarcinoma.
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DOI：
10.1245/s10434-021-10866-6
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发表时间：
2022-03
影响因子：
3.7
通讯作者：
Hakamada K
中科院分区：
文献类型：
--
作者：
Ishido K;Kimura N;Wakiya T;Nagase H;Hara Y;Kanda T;Fujita H;Hakamada K
可切除的胰腺导管腺癌（R-PDAC）常在根治性切除后早期复发，预后差。术前预测早期复发有助于确定最佳治疗方案。回顾性分析了2005年至2019年在广崎大学医院通过计算机断层扫描（CT）成像诊断为R-PDAC并接受根治性切除术的178例患者。术后6个月内复发的患者构成早期复发（ER）组，而其他患者构成非早期复发（non-ER）组。使用术前参数制定早期复发预测评分（ERP评分）。45例患者（25.3%）观察到ER。与非ER组相比，ER组的术前CA 19 -9（p = 0.03）、血清SPan-1（p = 0.006）和CT肿瘤直径（p = 0.01）显著更高。受试者工作特征（ROC）曲线分析确定了CA 19 -9（133 U/mL）、SPan-1（78.2 U/mL）和术前肿瘤直径（23 mm）的临界值。当参数超过临界值时，给予1分，并将三个因素的总分定义为ERP评分。ERP评分为3分的组的术后无复发生存期（RFS）为5.5个月（95% CI 3.02-7.98）。ER相关围手术期和手术因素的多变量分析确定ERP评分为3 [比值比（OR）4.63（95% CI 1.82-11.78），p = 0.0013]和R1切除[OR 3.20（95% CI 1.01-10.17），p = 0.049]是ER的独立预测因素。术前血清CA 19 -9、SPan-1水平和CT肿瘤直径可作为预测R-PDAC患者ER的评分指标，对鉴别预后差的患者和避免不必要的手术具有重要意义。
Resectable pancreatic ductal adenocarcinoma (R-PDAC) often recurs early after radical resection, which is associated with poor prognosis. Predicting early recurrence preoperatively is useful for determining the optimal treatment. One hundred and seventy-eight patients diagnosed with R-PDAC on computed tomography (CT) imaging and undergoing radical resection at Hirosaki University Hospital from 2005 to 2019 were retrospectively analyzed. Patients with recurrence within 6 months after resection formed the early recurrence (ER) group, while other patients constituted the non-early recurrence (non-ER) group. Early recurrence prediction score (ERP score) was developed using preoperative parameters. ER was observed in 45 patients (25.3%). The ER group had significantly higher preoperative CA19-9 (p = 0.03), serum SPan-1 (p = 0.006), and CT tumor diameter (p = 0.01) compared with the non-ER group. The receiver operating characteristic (ROC) curve analysis identified cutoff values for CA19-9 (133 U/mL), SPan-1 (78.2 U/mL), and preoperative tumor diameter (23 mm). When the parameter exceeded the cutoff level, 1 point was given, and the total score of the three factors was defined as the ERP score. The group with an ERP score of 3 had postoperative recurrence-free survival (RFS) of 5.5 months (95% CI 3.02–7.98). Multivariate analysis for ER-related perioperative and surgical factors identified ERP score of 3 [odds ratio (OR) 4.63 (95% CI 1.82–11.78), p = 0.0013] and R1 resection [OR 3.20 (95% CI 1.01–10.17), p = 0.049] as independent predictors of ER. For R-PDAC, ER could be predicted by the scoring system using preoperative serum CA19-9 and SPan-1 levels and CT tumor diameter, which may have great significance in identifying patients with poor prognoses and avoiding unnecessary surgery.
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