Dynamic serum alkaline phosphatase is an indicator of overall survival in pancreatic cancer
Dynamic serum alkaline phosphatase is an indicator of overall survival in pancreatic cancer
复制标题
动态血清碱性磷酸酶是胰腺癌总体生存的指标
DOI：
10.1186/s12885-019-6004-7
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发表时间：
2019-08-07
期刊：
影响因子：
3.8
通讯作者：
Yang, Haijun
中科院分区：
文献类型：
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作者：
Xiao, Yuanyuan;Lu, Jian;Yang, Haijun
背景血清碱性磷酸酶（ALP）在多种实体恶性肿瘤中的预后作用已被发现，但在胰腺癌中尚未被广泛讨论，特别是通过应用动态生存模型，其中包括不同性质的ALP measurement.MethodsWe进行了一项回顾性研究，成功地收集了551例组织病理学证实的胰腺导管腺癌（PDAC）来自中国西南部一家肿瘤专科医院的患者。采用动态Anderson-Gill（AG）模型评价PDAC患者生存期内ALP变异与总生存期（OS）的关系。结果在校正血清白蛋白、总胆红素和白细胞计数的可能混杂因素后，AG模型显示，生存期内血清ALP与PDAC的OS呈非线性相关：对于切除患者，与ALP结果在第一四分位数范围内的患者相比（<P25），ALP值在第2（P25-P50）、第3（P50-P75）和第4（>P75）四分位数的患者中，（95% CI：0.29-4.56），3.93（95% CI：1.23-12.60），3.87（95%CI：1.32-11.36）倍的死亡风险;而在未切除的PDAC患者中，风险比（HR）为1.15（95% CI：0.79-1.68）、1.92（95% CI：1.32-2.78）和1.97（95% CI：1.30-2.98）。敏感性分析显示，无论是切除和未切除的患者，AG模型的结果是强大的各种截止值的ALP，并增加ALP是在一般与显着增加的危险death.ConclusionSerum ALP在生存期与PDAC患者的OS显着相关，特别是对于切除早期PDAC患者。未来的研究，扩大样本量和完善的前瞻性设计，应实施，以证实我们的主要发现。此外，还应研究ALP这种可能的危险作用的潜在机制。
BackgroundThe prognostic role of serum alkaline phosphatase (ALP) has been found in several kinds of solid malignant tumor, but has never been extensively discussed in pancreatic cancer, especially through the application of dynamic survival model which incorporates the varying nature of ALP measurements.MethodsWe conducted a retrospective study which successfully collected 551 histopathologically confirmed pancreatic ductal adenocarcinoma (PDAC) patients from a cancer specialized hospital in southwest China. The association between variant ALP which measured during the whole survival period and the overall survival (OS) of PDAC patients was evaluated by using dynamic Anderson-Gill (AG) model. Exhaustive sensitivity analysis was performed by adopting continuous cut-offs of ALP.ResultsAfter adjusted for possible confounding of serum albumin, total bilirubin and leukocyte counts, AG model revealed that, serum ALP during the survival period was nonlinearly associated with the OS of PDAC: for resected patients, compared with those whose ALP results ranged within the first quartile (<P25), patients whose ALP measurements belonged to the second (P25-P50), the third (P50-P75), and the forth (>P75) quartiles were observed 1.14 (95% CI: 0.29–4.56), 3.93 (95% CI: 1.23–12.60), 3.87 (95% CI: 1.32–11.36) folds of death hazard; whereas in un-resected PDAC patients, the hazard ratios (HRs) were 1.15 (95% CI: 0.79–1.68), 1.92 (95% CI: 1.32–2.78), and 1.97 (95% CI: 1.30–2.98), respectively. Sensitivity analysis revealed that, for both resected and un-resected patients, the results of AG model were robust with regard to various cut-offs of ALP, and an increased ALP was in general associated with significantly increased hazard of death.ConclusionSerum ALP during the survival period was significantly associated with the OS of PDAC patients, especially for resected early stage PDAC patients. Future studies with expanded sample size and refined prospective design should be implemented to corroborate our major findings. Besides, the underlying mechanism for this possible hazardous role of ALP should also be investigated.