Prognostic value of CA 19-9 levels in patients with carcinoma of the pancreas treated with radiotherapy
Prognostic value of CA 19-9 levels in patients with carcinoma of the pancreas treated with radiotherapy
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DOI：
10.1016/s0360-3016(98)00058-3
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发表时间：
1998-05-01
影响因子：
7
通讯作者：
Coia, L
中科院分区：
文献类型：
--
作者：
Katz, A;Hanlon, A;Coia, L
目的：CA 19 - 9已被确定为胰腺癌的肿瘤标志物，并已被证明在预测手术治疗患者的结果方面具有一定的实用性。本研究的目的是评估其有用性作为一个预后指标，在患者接受放疗treated with radiotherapy. Materials and Methods：一个回顾性分析的所有患者接受放射治疗的明确意图（n = 104），胰腺癌在福克斯大通癌症中心从1980年至1994年进行。患者分为4组：计划术前放疗伴切除（n = 25）;计划术前放疗未成功切除（n = 35）;术后放疗（n = 21）;和放疗未计划切除（n = 23）。对于每组，除未计划切除的治疗外，外照射放疗的中位剂量为50.4戈伊（范围= 21.6 - 63.0戈伊）。其余第四组的患者接受的中位剂量为55.8戈伊（范围= 36.0 - 60.4戈伊）。前三组中97%的患者也接受了以5-FU为基础的化疗，第四组中61%的患者也接受了化疗。治疗前和随访CA 19 - 9水平为69 patients.Results：所有组的中位生存时间为10个月（范围= 1 - 67个月）。单变量分析显示各组的生存率存在显著差异：术前切除22个月;术前未切除10个月，术后17个月;未计划切除12个月（p = 0.0005）。总体而言，接受切除术的患者的中位生存时间为19个月，而未接受切除术的患者为11个月（p = 0.0006）。在单变量分析中，发现诊断时的CA 19 - 9水平是一个重要的预后指标，在那些水平大于中位数的患者中，中位生存时间为8个月。680 U/ml，相比之下，20个月的那些没有（p = 0.0003）。同样，治疗后的最低点也是显著的，水平高于中位数162.5 U/ml的患者的中位生存时间为11个月，而水平低于162.5 U/ml的患者为26个月（p = 0.001）。治疗后CA 19 - 9水平下降超过75%的患者的中位生存时间为23个月（范围= 6 - 34个月），而缓解率为75%或更低的患者为8个月（范围= 3 - 21）（p = 0.003）。在逐步多变量分析中，发现治疗前CA 19 - 9水平是生存率的显著预测因子（p = 0.005）。其他潜在的预后指标，包括年龄，性别，KPS，诊断前体重减轻，肿瘤的位置，临床TNM分期，病变的大小，血管受累的血管造影，和相对于切除放射治疗的顺序进行了评估，并没有发现是显着的。其他比较传统的成果指标用处不大。(C)1998年爱思唯尔科学公司
Purpose: CA 19-9 has been identified as a tumor marker for pancreatic carcinoma and has been shown to have some utility in predicting outcome in surgically treated patients. The purpose of this study was to evaluate its usefulness as a prognostic indicator in patients treated with radiotherapy.Materials and Methods: A retrospective review of all patients treated with radiotherapy of definitive intent (n = 104) for carcinoma of the pancreas at Fox Chase Cancer Center from 1980-1994 was undertaken. Patients were categorized into four groups: Planned preoperative radiation with resection (n = 25); planned preoperative radiation without successful resection (n = 35); postoperative radiation (n = 21); and radiation without planned resection (n = 23). For each group, except those treated without planned resection, median dose for external beam radiotherapy was 50.4 Gy (range = 21.6-63.0 Gy). Those in the remaining fourth group were treated with a median dose of 55.8 Gy (range = 36.0-60.4 Gy). 97% of patients in the first three groups were also treated with 5-FU-based chemotherapy, as were 61% of those in the fourth group. Pretreatment and follow-up CA 19-9 levels were available for 69 patients.Results: Median survival time for all groups was 10 months (range = 1-67 months). Univariate analysis showed significant differences in survival among the groups: Preop with resection 22 months; preop without resection 10 months, postop 17 months; and without planned resection 12 months (p = 0.0005). Overall, patients who underwent resection had a median survival time of 19 months, compared to 11 months in those who did not (p = 0.0006). CA 19-9 level at diagnosis was found to be a significant prognostic indicator on univariate analysis, with a median survival time of 8 months in those having a level greater than the median! of 680 U/ml, compared to 20 months in those who did not (p = 0.0003). Similarly, the posttreatment nadir was significant, with a median survival time of 11 months in those with levels above the median of 162.5 U/ml, vs. 26 months in those with levels below 162.5 U/ml (p = 0.001). The median survival time for patients whose CA 19-9 levels decreased in response to treatment by more than 75% was 23 months (range = 6-34 months) vs. 8 months (range = 3-21) in those with 75% or less response (p = 0.003). On stepwise multivariate analysis, pretreatment CA 19-9 level was found to be a significant predictor of survival (p = 0.005). Other potential indicators of outcome, including age, gender, KPS, prediagnosis weight loss, location of tumor, clinical TNM staging, size of lesion, vascular involvement on angiography, and sequence of radiation with respect to resection, were evaluated and were not found to be significant.Conclusion: CA 19-9 was demonstrated to be a useful prognostic indicator in patients treated with radiotherapy; other, more traditional, indicators of outcome were of less utility. (C) 1998 Elsevier Science Inc.