Prognostic significance of carbohydrate antigen 19-9 in unresectable locally advanced pancreatic cancer treated with dose-escalated intensity modulated radiation therapy and concurrent full-dose gemcitabine: analysis of a prospective phase 1/2 dose escalation study.
Prognostic significance of carbohydrate antigen 19-9 in unresectable locally advanced pancreatic cancer treated with dose-escalated intensity modulated radiation therapy and concurrent full-dose gemcitabine: analysis of a prospective phase 1/2 dose escalation study.
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DOI：
10.1016/j.ijrobp.2012.11.020
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发表时间：
2013-05-01
影响因子：
7
通讯作者：
Ben-Josef, Edgar
中科院分区：
文献类型：
--
作者：
Vainshtein, Jeffrey M.;Schipper, Matthew;Zalupski, Mark M.;Lawrence, Theodore S.;Abrams, Ross;Francis, Isaac R.;Khan, Gazala;Leslie, William;Ben-Josef, Edgar
尽管糖链抗原19-9（CA 19 -9）是在切除术后建立的，但其在不可切除的局部晚期胰腺癌（LAPC）中的预后价值尚不清楚。我们研究了CA 19 -9在接受调强放疗（IMRT）剂量递增联合吉西他滨治疗的不可切除LAPC患者中的预后效用。46例不可切除的LAPC患者在密歇根大学接受了IMRT剂量递增与吉西他滨同时治疗的1/2期试验。在基线和常规随访期间获得CA 19 -9。使用考克斯模型评估基线因素对无局部进展（FFLP）、远端进展（FFDP）、无进展生存期（PFS）和总生存期（OS）的影响。使用逐步前向回归建立每个终点的多变量预测模型。38例患者符合本分析的条件。在单变量分析中，基线CA 19 -9和年龄预测OS，基线和3个月时的CA 19 -9预测PFS，大体肿瘤体积（GTV）和黑人预测FFLP，3个月时的CA 19 -9预测FFDP。在逐步多变量回归模型中，基线CA 19 -9、年龄和女性性别预测OS;基线CA 19 -9和女性性别预测PFS和FFDP; GTV预测FFLP。基线CA 19 -9 ≤90 U/mL的患者的OS（中位数23.0 vs 11.1个月，HR 2.88，P<0.01）和PFS（14.4 vs 7.0个月，HR 3.61，P = 0.001）有所改善。CA 19 -9进展超过90 U/mL是OS（HR 3.65，P = .001）和PFS（HR 3.04，P = .001）的预后指标，并且是比局部进展（HR 1.46，P = .42）或远处进展（HR 3.31，P = .004）更强的死亡预测因子。在接受确定性放化疗的不可切除LAPC患者中，即使在已确定的预后因素得到控制后，基线CA 19 -9也是独立的预后因素，而CA 19 -9进展强烈预测疾病进展和死亡。未来的试验应根据基线CA 19 -9进行分层，并将CA 19 -9进展作为疾病进展的标准。
Although established in the postresection setting, the prognostic value of carbohydrate antigen 19-9 (CA19-9) in unresectable locally advanced pancreatic cancer (LAPC) is less clear. We examined the prognostic utility of CA19-9 in patients with unresectable LAPC treated on a prospective trial of intensity modulated radiation therapy (IMRT) dose escalation with concurrent gemcitabine. Forty-six patients with unresectable LAPC were treated at the University of Michigan on a phase 1/2 trial of IMRT dose escalation with concurrent gemcitabine. CA19-9 was obtained at baseline and during routine follow-up. Cox models were used to assess the effect of baseline factors on freedom from local progression (FFLP), distant progression (FFDP), progression-free survival (PFS), and overall survival (OS). Stepwise forward regression was used to build multivariate predictive models for each endpoint. Thirty-eight patients were eligible for the present analysis. On univariate analysis, baseline CA19-9 and age predicted OS, CA19-9 at baseline and 3 months predicted PFS, gross tumor volume (GTV) and black race predicted FFLP, and CA19-9 at 3 months predicted FFDP. On stepwise multivariate regression modeling, baseline CA19-9, age, and female sex predicted OS; baseline CA19-9 and female sex predicted both PFS and FFDP; and GTV predicted FFLP. Patients with baseline CA19-9 ≤90 U/mL had improved OS (median 23.0 vs 11.1 months, HR 2.88, P<.01) and PFS (14.4 vs 7.0 months, HR 3.61, P = .001). CA19-9 progression over 90 U/mL was prognostic for both OS (HR 3.65, P = .001) and PFS (HR 3.04, P = .001), and it was a stronger predictor of death than either local progression (HR 1.46, P = .42) or distant progression (HR 3.31, P = .004). In patients with unresectable LAPC undergoing definitive chemoradiation therapy, baseline CA19-9 was independently prognostic even after established prognostic factors were controlled for, whereas CA19-9 progression strongly predicted disease progression and death. Future trials should stratify by baseline CA19-9 and incorporate CA19-9 progression as a criterion for progressive disease.
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影响因子：
45.3
作者：
Ferrone, Cristina R.;Finkelstein, Dianne M.;Warshaw, Andrew L.
通讯作者：
Warshaw, Andrew L.
影响因子：
45.3
作者：
Loehrer, Patrick J., Sr.;Feng, Yang;Benson, Al B., III
通讯作者：
Benson, Al B., III
影响因子：
3.2
作者：
Hernandez, Jonathan M.;Cowgill, Sarah M.;Rosemurgy, Alexander
通讯作者：
Rosemurgy, Alexander
DOI：
10.1016/s0360-3016(98)00058-3
发表时间：
1998-05-01
影响因子：
7
作者：
Katz, A;Hanlon, A;Coia, L
通讯作者：
Coia, L
DOI：
10.1016/j.ijrobp.2012.02.051
发表时间：
2012-12-01
影响因子：
7
作者：
Ben-Josef, Edgar;Schipper, Mathew;Zalupski, Mark M.
通讯作者：
Zalupski, Mark M.