CA 19-9 is an index of response to neoadjunctive chemoradiation therapy in pancreatic cancer
CA 19-9 is an index of response to neoadjunctive chemoradiation therapy in pancreatic cancer
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DOI：
10.1016/s0002-9610(97)89547-5
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发表时间：
1996-10-01
影响因子：
3
通讯作者：
Warshaw, AL
中科院分区：
文献类型：
--
作者：
Willett, CG;Daly, WJ;Warshaw, AL
目的：本研究探讨胰腺癌患者在新辅助放疗和化疗后血清CA 19-9水平的变化，以确定这一肿瘤标志物在这些患者术前管理中的潜在作用。材料和方法：42例患者在接受5-氟尿嘧啶同步外束照射准备开腹和惠普尔手术或术中放疗（IORT）前，测定血清CA 19-9水平。照射后再次检测CA 19-9水平，其变化与CT扫描及开腹检查结果相关。术前放疗后，10例（24%）患者的CA 19-9水平升高，29例（69%）患者的CA 19-9水平下降，治疗后3例（7%）患者的CA 19-9水平没有变化。在放疗后CA 19-9水平升高的10例患者中，9例（90%）发生远处转移或局部肿瘤进展，这是通过重新扫描CT或剖腹手术确定的。相比之下，29例放疗后CA 19-9水平下降的患者中只有6例（21%）在再分期CT扫描或剖腹手术时显示转移或局部肿瘤进展。CA 19-9升高或降低与病情进展或对照的相关性均有统计学意义（P = 0.009）。在新辅助治疗期间，血清CA 19-9水平可能升高或下降，CA 19-9升高可靠地表明癌症进展，而CA 19-9下降意味着大多数患者的疾病得到控制。在制定胰腺癌新辅助治疗应用策略时，CA 19-9的监测对于识别尽管接受了新辅助治疗，但仍表现出肿瘤进展性生长和转移的患者最有用。
PURPOSE: This Study examines the changes of serum levels of CA 19-9 in patients with pancreatic cancer following neoadjuvant irradiation and chemotherapy to define the potential role of this tumor marker in preoperative management of these patients,MATERIALS AND METHODS: Serum CA 19-9 levels were measured in 42 patients before receiving external beam irradiation with concurrent 5-fluorouracil in preparation for laparotomy and Whipple procedure or intraoperative irradiation (IORT). The CA 19-9 levels were determined again after irradiation, and changes were correlated with findings of restaging computed tomography (CT) scan and laparotomy,RESULTS: Following preoperative irradiation, 10 patients (24%) experienced an increase in CA 19-9 levels whereas 29 patients (69%) showed a decrease in CA 19-9, There was no change in the CA 19-9 levels of 3 patients (7%) after treatment, Of the 10 patients with increased CA 19-9 levels after irradiation, 9 (90%) had developed distant metastases or local tumor progression as determined by restaging CT scan or at laparotomy. In contrast, only 6 of 29 patients (21%) with declining CA 19-9 levels after irradiation demonstrated metastases or local tumor progression on restaging CT scan or at laparotomy. The correlation of CA 19-9 increase or decrease with disease progression or control, respectively, was statistically significant (P = 0.009),CONCLUSIONS: Serum CA 19-9 levels may rise or fall during neoadjuvant therapy, A rising CA 19-9 reliably indicates cancer progression while a falling CA 19-9 connotes disease control in the majority of patients, In developing strategies for application of neoadjuvant therapy for pancreatic cancer, monitoring of CA 19-9 appears most useful for the identification of patients who manifest progressive tumor growth and metastasis in spite of this treatment.