Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation.
Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation.
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DOI：
10.1245/s10434-010-0943-1
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发表时间：
2010-07
影响因子：
3.7
通讯作者：
Evans DB
中科院分区：
文献类型：
--
作者：
Katz MH;Varadhachary GR;Fleming JB;Wolff RA;Lee JE;Pisters PW;Vauthey JN;Abdalla EK;Sun CC;Wang H;Crane CH;Lee JH;Tamm EP;Abbruzzese JL;Evans DB
碳水化合物抗原（CA） 19-9在计划手术切除前接受新辅助治疗的可切除胰腺癌患者评估中的作用尚不清楚。我们在最近报道的两项临床试验中评估了CA 19-9作为治疗反应、治疗完成和患者生存的标志。我们分析了在两项II期试验中接受新辅助放化疗的可放射切除的头/钩突腺癌患者。放化疗后无疾病进展的患者行胰十二指肠切除术（PD）。在胆红素水平正常的患者中评估CA 19-9。我们纳入174例患者，其中119例（68%）完成了包括PD在内的所有治疗。预处理CA 19-9 <37 U/ml对完成PD的阳性预测值（PPV）为86%，阴性预测值（NPV）为33%。在最后随访时无疾病证据的患者中，预处理CA 19-9最高为1,125 U/ml。在可切除的PD患者中，CA 19-9 <61 U/ml的再移植PPV为93%，NPV为28%。预处理和恢复CA 19-9水平完成PD的受体-工作特征曲线下面积分别为0.59和0.74。我们发现CA 19-9的变化与组织病理反应之间没有关联（P = 0.74）。虽然CA 19-9完成新辅助治疗并接受PD的PPV很高，但其临床应用受到低NPV的影响。可切除PC患者的决策应基于临床评估和影像学分期。
The role of carbohydrate antigen (CA) 19-9 in the evaluation of patients with resectable pancreatic cancer treated with neoadjuvant therapy prior to planned surgical resection is unknown. We evaluated CA 19-9 as a marker of therapeutic response, completion of therapy, and survival in patients enrolled on two recently reported clinical trials. We analyzed patients with radiographically resectable adenocarcinoma of the head/uncinate process treated on two phase II trials of neoadjuvant chemoradiation. Patients without evidence of disease progression following chemoradiation underwent pancreaticoduodenectomy (PD). CA 19-9 was evaluated in patients with a normal bilirubin level. We enrolled 174 patients, and 119 (68%) completed all therapy including PD. Pretreatment CA 19-9 <37 U/ml had a positive predictive value (PPV) for completing PD of 86% but a negative predictive value (NPV) of 33%. Among patients without evidence of disease at last follow-up, the highest pretreatment CA 19-9 was 1,125 U/ml. Restaging CA 19-9 <61 U/ml had a PPV of 93% and a NPV of 28% for completing PD among resectable patients. The area under the receiver-operating characteristics curve of pretreatment and restaging CA 19-9 levels for completing PD was 0.59 and 0.74, respectively. We identified no association between change in CA 19-9 and histopathologic response (P = 0.74). Although the PPV of CA 19-9 for completing neoadjuvant therapy and undergoing PD was high, its clinical utility was compromised by a low NPV. Decision-making for patients with resectable PC should remain based on clinical assessment and radiographic staging.
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影响因子：
45.3
作者：
Evans, Douglas B.;Varadhachary, Gauri R.;Wolff, Robert A.
通讯作者：
Wolff, Robert A.
影响因子：
3.7
作者：
Talamonti, MS;Small, W;McGinn, CJ
通讯作者：
McGinn, CJ
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：
3
作者：
Willett, CG;Daly, WJ;Warshaw, AL
通讯作者：
Warshaw, AL
影响因子：
2.2
作者：
Kang, Chang Moo;Kim, Jun Young;Kim, Byong Ro
通讯作者：
Kim, Byong Ro