Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma
Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma
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DOI：
10.1200/jco.2005.05.3934
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发表时间：
2006-06-20
影响因子：
45.3
通讯作者：
Warshaw, Andrew L.
中科院分区：
文献类型：
--
作者：
Ferrone, Cristina R.;Finkelstein, Dianne M.;Warshaw, Andrew L.
目的不同的预后因素对胰腺癌患者进行分层。本研究的目的是确定术前CA 19 -9水平是否可以预测疾病或生存期的阶段，是否在术前术后CA 19 -9或术后CA 19 -9预测总survival.Patients和方法424例胰腺癌患者进行切除术1985年1月1日至2004年1月1日。在胆红素低于2 mg/dL的患者中，176例术前有CA 19 -9值，111例术前和术后有CA 19 -9值。从术后首次测量CA 19 -9水平（中位数，39天）至死亡或末次随访测量生存率。采用临床、手术、病理和辅助治疗特征拟合多因素失败时间模型，并根据术前和术后CA 19 -9的值和变化进行分类。结果176例患者中，128例（73%）为T3病变，99例（56 /0）为N1病变; 138例（78%）接受了胰腺癌切除术。NO患者术前CA 19 -9水平中位数低于阳性淋巴结患者（分别为9 v164 U/mL;非参数P = 0.06），T1/T2患者低于T3患者（分别为41 v162 U/mL; P = 0.03）。中位随访时间（n = 111）为1.8年（范围：1 - 12.9年），总体精算1年、3年和5年生存率分别为70%、36%和30%。多因素分析显示，CA 19 -9降低（P = .0005）、淋巴结阴性（P = .001）、T分期降低（P = .0008）、术后CA 19 -9低于200 U/mL（P = .0007）是胰腺癌患者生存的重要预测因素。术后CA 19 -9降低和术后CA 19 -9值小于200 U/mL是生存的强独立预测因子，即使在调整分期后也是如此。CA 19 -9水平应包括在患者的围手术期护理中，并应考虑用于预后列线图。
Purpose Different prognostic factors stratify patients with pancreatic adenocarcinoma. The purpose of this study was to determine whether preoperative CA19-9 levels can predict stage of disease or survival and whether a change in preoperative to postoperative CA19-9 or the postoperative CA19-9 predicts overall survival.Patients and Methods Four hundred twenty-four consecutive patients with pancreatic adenocarcinoma underwent resection between January 1, 1985 and January 1, 2004. Of the patients with a bilirubin less than 2 mg/dL, 176 had preoperative CA19-9 values, and 111 had pre- and postoperative CA19-9 values. Survival was measured from the first postoperative CA19-9 level measured (median, 39 days) until death or last follow-up. A multivariate failure time model was fit using clinical, operative, pathologic, and adjuvant treatment characteristics, and a categorization was defined by the values and changes in CA19-9 before and after surgery.Results Of the 176 patients, 128 (73%) had T3 lesions, and 99 (56 /0) had N1 disease; 138 patients (78%) underwent pancreaticoduodenectomy. Median preoperative CA19-9 levels were lower in NO patients compared with patients with positive nodes (nine v 164 U/mL, respectively; nonparametric P = .06) and in T1/T2 patients versus T3 patients (41 v162 U/mL, respectively; P = .03). Median follow-up time (n = 111) was 1.8 years (range, 1 to 12.9 years), with overall actuarial 1-, 3-, and 5-year survival rates of 70%, 36%, and 30%, respectively. Significant predictors of survival on multivariate analysis included a decrease in CA19-9 (P = .0005), negative lymph nodes (P = .001), lower T stage (P = .0008), and postoperative CA19-9 less than 200 U/mL (P = .0007).Conclusion In patients with pancreatic adenocarcinoma, preoperative CA19-9 correlates with stage of disease. Both a postoperative decrease in CA19-9 and a postoperative CA19-9 value of less than 200 U/mL are strong independent predictors of survival, even after adjusting for stage. CA19-9 levels should be included in a patient's perioperative care and should be considered for prognostic nomograms.