The combination of preoperative D-dimer and CA19-9 predicts lymph node metastasis and survival in intrahepatic cholangiocarcinoma patients after curative resection
The combination of preoperative D-dimer and CA19-9 predicts lymph node metastasis and survival in intrahepatic cholangiocarcinoma patients after curative resection
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术前D-二聚体和CA19-9联合预测肝内胆管癌患者根治性切除术后的淋巴结转移和生存
DOI：
10.21037/atm.2020.01.72
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发表时间：
2020-03-01
影响因子：
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通讯作者：
Wu, Jianxiong
中科院分区：
文献类型：
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作者：
Chen, Qichen;Zheng, Yiling;Wu, Jianxiong
目的探讨D-二聚体及其联合术前CA 19 -9对肝内胆管癌（ICC）根治性切除术后淋巴结转移（LNM）及预后的预测作用。方法选取2012年4月至2018年12月在我院住院的173例患者。术前D-二聚体和CA 19 -9（CPDC）的组合评分为0（D-二聚体水平降低伴CA 19 -9水平降低）、2（D-二聚体水平升高伴CA 19 -9水平升高）或1（所有其他组合）。进行多因素Logistic回归分析以确定独立因素。采用考克斯比例风险回归进行多因素生存分析。结果多因素分析显示，CPDC评分是LNM和总生存期（OS）的独立预测因子。对于LNM的预测，CPDC评分的曲线下面积（AUC）为0.722（95%CI：0.613-0.831，P<0.001），对于生存期的预测，CPDC评分的AUC为0.756（95%CI：0.658-0.854，P<0.001）。CPDC评分的预测能力高于D-二聚体或CA 19 -9。Kaplan-Meier曲线分析显示，在ICC患者中，与CPDC =1或CPDC =0相比，CPDC =2与更差的OS（P<0.001，中位OS：8.00 vs 19.00个月vs未达到）和更短的无进展生存期（PFS）（P<0.001，中位PFS：4.00 vs 11.00 vs 15.00个月）显著相关。任何两组之间的OS比较均存在显着差异。除HBsAg（+）组外，在所有亚组中，术前CPDC降低与OS和PFS恶化相关。在肝硬化、HBsAg（−）和肿瘤大小≥5 cm亚组中，任何两组之间的OS和PFS比较存在显著差异。结论术前CPDC评分是预测ICC患者根治性切除术后LNM和OS的一个方便、有效的预后指标。特别是对于放射学阴性的ICC患者，CPDC有助于评估淋巴结清扫范围和制定随访计划。
Background To investigate the predictive role of D-dimer and its combination of preoperative CA19-9 for lymph node metastasis (LNM) and prognosis in intrahepatic cholangiocarcinoma (ICC) patients who underwent curative-intent resection. Methods One hundred and seventy-three patients admitted to our hospital between April 2012 and December 2018 were included. The combination of preoperative D-dimer and CA19-9 (CPDC) was scored as 0 (decreased D-dimer levels with decreased CA19-9 levels), 2 (elevated D-dimer levels with elevated CA19-9 levels), or 1 (all other combinations). Multivariate logistic regression analysis was performed to identify independent factors. Cox proportional hazard regression was adopted for the multivariate survival analysis. Results The CPDC score was an independent predictor of LNM and overall survival (OS) in the multivariate analyses. For the prediction of LNM, the area under the curve (AUC) for the CPDC score was 0.722 (95% CI: 0.613–0.831, P<0.001), and for the prediction of survival, the AUC for the CPDC score was 0.756 (95% CI: 0.658–0.854, P<0.001). The predictive capacity of the CPDC score was higher than that of D-dimer or CA19-9. Kaplan-Meier curve analysis revealed that a CPDC =2 was significantly associated with a worse OS (P<0.001, median OS: 8.00 versus 19.00 months versus not reached) and shorter progression-free survival (PFS) (P<0.001, median PFS: 4.00 versus 11.00 versus 15.00 months) than a CPDC =1 or CPDC =0 in ICC patients. There were significant differences in the OS comparisons between any two groups. Decreased preoperative CPDC was associated with worse OS and PFS in all subgroups except in the HBsAg (+) group. In the cirrhosis, HBsAg (−) and tumour size ≥5 cm subgroups, there were significant differences in the OS and PFS comparisons between any two groups. Conclusions The preoperative CPDC score is a convenient and powerful prognostic biomarker to predict LNM and OS for ICC patients after curative resection. Especially for radiologically-negative metastatic lymph node in ICC patients, CPDC could be helpful to assess the extent of lymph node dissection and make follow-up plans.