肝、胰头、十二指肠联合切除并肝移植治疗肝门部胆管癌1例

背景：由于肝门部解剖学的特殊性和复杂性,肝门部胆管癌长期以来都是外科治疗中的难点。 目的：评价肝、胰头、十二指肠联合切除并肝移植治疗晚期肝门部胆管癌的安全性和可行性。 方法：对1例Bismuth分型为Ⅳ型且合并肝门部及胰头后淋巴结转移的肝门部胆管癌患者实施肝、胰头、十二指肠联合切除并原位肝移植。肝移植后初期采用激素、他克莫司及吗替麦考酚酯三联免疫抑制治疗,激素用量较常规小并迅速撤除。对早期肝功能及胰腺功能进行连续观察,并对肿瘤标志物CA19-9进行监测。 结果与结论：病理报告为中、低分化性肝门部胆管癌侵犯左、右肝管并肝方叶、肝门部及胰头后淋巴结有转移,胰头、十二指肠及切除部分胃未见癌侵犯。肝移植后患者肝功能恢复顺利,胰腺内、外分泌功能保持良好,CA19-9降至正常。术后1个月患者痊愈出院,随访1年,患者仍生存。说明肝、胰头、十二指肠联合切除并肝移植治疗肝门部胆管癌是安全可行的。     

影响肝胆管细胞癌手术预后的临床病理学因素分析

目的分析影响肝胆管细胞癌(ICC)患者手术预后的临床病理学因素。方法回顾性分析行根治性肝切除术的112例ICC患者的临床资料,统计患者术后1年、3年、5年累积生存率,通过单因素和多因素分析影响ICC患者预后的危险因素,并制作列线图模型。结果112例患者的中位生存期为27个月,术后1年、3年及5年的累积生存率分别为72.8%、40.7%、34.0%。单因素分析结果显示,癌胚抗原(CEA)、CA19-9、碱性磷酸酶(ALP)、HbsAg、胆管扩张、血管侵犯、局部侵犯、淋巴结转移、卫星结节、肿瘤分化程度、手术切除范围以及肿瘤TNM分期是影响ICC患者肝切除术预后的相关因素;多因素分析结果显示,HbsAg阴性、血管侵犯、卫星结节、肿瘤中低分化以及肿瘤TNM分期为ⅢA/ⅢB期是影响ICC患者预后的独立危险因素。根据多因素分析结果制作的列线图模型能较好地预测ICC患者的术后生存期。结论HbsAg阴性、血管侵犯、卫星结节、肿瘤中低分化以及肿瘤TNM分期为ⅢA/ⅢB期是影响ICC患者根治性肝切除术后生存期的独立危险因素。     

基于术前增强CT构建列线图模型预测胰腺导管腺癌R0切除

目的:探讨术前增强CT扫描特征结合临床特征构建列线图模型预测胰腺导管腺癌（PDAC）是否能达到R0切除。方法:回顾性分析经手术病理证实且进行切缘状态评估的106例PDAC患者的术前增强CT成像资料,依据切缘状态分为R0切除组与R1切除组。分析患者术前CA199、CA125、CEA等临床资料;观测术前增强CT肿瘤部位、肿瘤横径、肿瘤与周围血管的最大夹角（T/动脉夹角、T/门静脉夹角、T/肠系膜上静脉夹角）、瘤周脂肪间隙以及淋巴结转移等特征;随后对两组患者进行单因素、多因素Logistic回归构建列线图模型术前预测PDAC是否能达到R0切除。结果:R0切除组与R1切除组在肿瘤横径、CA199、CA125、CEA、T/动脉夹角、T/门静脉夹角、T/肠系膜上静脉夹角及淋巴结转移的差异有统计学意义（P<0.05）。单因素及多因素Logistic回归分析表明淋巴结转移［OR:0.205（95%CI:0.043~0.972）, P<0.05］、T/动脉夹角［OR:0.085（95%CI:0.017~0.434）, P<0.01］、T/门静脉夹角［OR:0.155（95%CICI:0.031~0.783）, P<0.05］、肿瘤横径［OR:1.073（95%CI:1.004~1.146）, P<0.05］、CA199［OR:1.003（95%CI:1.001~1.005）, P<0.01］是R0切除的独立危险因子。通过多因素Logistic回归构建的模型能有效预测PDAC的R0切除。校准曲线表明列线图模型预测概率能较好拟合实际概率,校准度高。结论:术前较低水平的CA199、较短的肿瘤横径、T/动脉夹角及T/门静脉夹角<180°、非淋巴结转移状态是PDAC的R0切除的独立预测因子,列线图模型能有效预测PDAC是否能达到R0切除。     

Combined detection of preoperative serum CEA,CA19-9 and CA242 improve prognostic prediction of surgically treated colorectal cancer patients

We assessed the prognostic significance of preoperative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 242 (CA242) levels in surgically treated colorectal cancer patients. The relationship of preoperative serum CEA, CA19-9 and CA242 levels with disease characteristics was investigated in 310 patients. Correlation between tumor markers was investigated using Pearson correlation test. Univariate and multivariate survival analyses were used to study the relationship between preoperative tumor markers and prognosis [disease free survival (DFS) and overall survival (OS)]. Kaplan-Meier analysis with log rank test was used to assess the impact of tumor marker levels on survival. Positive rate of preoperative serum CEA, CA19-9 and CA242 were 54.84%, 47.42% and 37.10%, respectively. High preoperative CEA level was associated with tumor size (P = 0.038), T stage (P < 0.001) and AJCC stage (P = 0.002). High preoperative CA19-9 level was associated with tumor AJCC stage (P = 0.023). Preoperative CA242 positively correlated with CEA (P < 0.001) and CA19-9 (P < 0.001). Combining the three markers was of independent prognostic value in CRC (HR = 2.532, 95% CI: 1.400-4.579, P = 0.002 for OS; and HR = 2.366, 95% CI: 1.334-4.196, P = 0.003 for DFS). Combined detection of preoperative serum CEA, CA19-9 and CA242 is of independent prognostic value for management of CRC patients treated surgically.     

Expression of matrix metalloproteinase 7 is an unfavorable postoperative prognostic factor in cholangiocarcinoma of the perihilar, hilar, and extrahepatic bile ducts

Cholangiocarcinoma of the perihilar, hilar, and extrahepatic bile ducts (collectively referred to as the large bile ducts) is an intractable disease, and a papillary phenotype and well-differentiated histologic grade have been proposed as indicators of a favorable prognosis after surgical resection. In this study, we examined the significance of matrix metalloproteinases (MMPs) in cholangiocarcinoma with respect to clinicopathologic features. We subjected 66 surgically resected specimens of cholangiocarcinoma of the large bile ducts to clinicopathologic examination, including postoperative survival, papillary phenotype, and immunohistochemical expression of MMP-2,-7, -9, and membrane type 1 MMP (MT1-MP). Nonneoplastic biliary epithelium did not express these 4 MMPs, whereas cholangiocarcinoma frequently expressed MMP-2 (33.9%), -7 (75.8%), -9 (47.5%), and MT1-MMP (54.5%). In particular, conventional (nonpapillary) cholangiocarcinoma expressed MMP-7 and MT1-MMP more frequently than papillary cholangiocarcinoma. The expression of MMP-7 and MT1-MMP significantly correlated with the nonpapillary phenotype, poorly differentiated histologic grade, perineural invasion, and advanced TNM stage. In contrast, the expression of MMP-2 and -9 was not associated with any of the clinicopathologic features. Univariate analysis of disease-specific survival revealed that a papillary phenotype and expression of MMP-7 were prognostic factors of cholangiocarcinoma, in addition to TNM stage, poorly differentiated histologic grade, perineural invasion, and microscopic margin status. Multivariate analysis showed only TNM stage to be an independent prognostic factor. Expression of MMP-7 in cholangiocarcinoma is an unfavorable postoperative prognostic factor of cholangiocarcinoma arising from the large bile ducts. Underexpression of MMPs in papillary cholangiocarcinoma might be associated with a favorable prognosis.     

卵巢癌患者调节性T细胞比率和肿瘤标志物CA125、CA19-9测定及临床意义

目的 探讨卵巢癌患者、卵巢良性疾病及健康成人女性调节性T细胞（Tregs）和肿瘤标志物CA125、CA19-9水平的差异,并将其与临床病理因素及预后进行相关分析。 方法 选择2016年10月~2017年10月承德医学院附属医院妇科收治的经病理确诊的卵巢癌患者43例,设为恶性组,另选择同期医院收治的卵巢良性疾病患者55例作为良性组,健康体检妇女50例作为对照组。比较3组患者Tregs和肿瘤标志物CA125、CA19 9在卵巢癌患者中的表达水平,分析其与临床病理因素及预后的关系。 结果 恶性组和良性组Tregs比例、CA125和CA19-9水平均高于对照组,恶性组Tregs比例、CA125和CA19-9水平高于良性组（P<0.05）。CA125、CA19-9、Tregs水平与患者的年龄差异无显著性（P>0.05）;CA125水平与卵巢癌患者的淋巴结是否转移、肿瘤分期和组织学类型均有关;Tregs表达水平与卵巢癌患者的淋巴结是否转移和肿瘤分期均相关,CA19-9水平只与肿瘤分期相关（P<0.05）。随访12个月后,Tregs-low组中位生存时间高于Tregs-high组（P<0.05）。卵巢癌中Tregs数与CA125存在显著正相关性（P<0.05）,而与CA19-9不具有相关性（P>0.05）。 结论 Tregs、CA125和CA19-9均可有望成为卵巢癌临床诊断、治疗和预后的指标。     

Clinical significance and prognostic value of CA72-4 compared with CEA and CA19-9 in patients with gastric cancer

Carcinoembryonic antigen (CEA) and CA 19-9 are both widely used in the follow up of patients with gastrointestinal cancer. More recently another tumor marker, named CA 72-4 has been identified and characterized using two different monoclonal antibodies B72.3 and CC49. Several reports evaluated CA 72-4 as a serum tumor marker for gastric cancer and compared its clinical utility with that of CEA or CA 19-9; few reports concerned its prognostic value. In the present study, CA 72-4 is evaluated and compared with CEA and CA 19-9 in various populations of patients with gastric cancer and benign disease; for 52 patients with gastric adenocarcinoma and 57 patients without neoplastic disease CEA, CA 19-9 and CA 72-4 were evaluated before treatment. Sensitivity of the tumor markers CA 72-4, CA 19-9 and CEA at the recommended cut-off level in all 52 patients were 58%, 50% the sensitivity increased to 75%. of these markers, for non metastatic patients, multivariate analyses indicated that none of the markers were significant, when adjusted for gender and age (which were indicators of poor prognosis); patients with abnormal values of CA72-4 tended to have shorter survival than patients with normal values (p<0.07). In the metastatic population, only high values of CA19-9 (p<0.02) and gender (women) p<0.03) were indicators of poor prognosis in univariate analysis; multivariate analysis revealed that both CA72-4 (p=0.034) and CA19-9 p=0.009), adjusted for gender were independent prognostic factors. However, CA72-4 lost significance (p=0.41) when adjusted for CA19-9 and gender, indicating that CA19-9 provides more prognostic information than CA72-4. When limited to the metastatic male population with normal values of CA 19-9 and CEA, CA 72-4 pretherapeutic positive levels were associated with a worse prognosis (p<0.005). In conclusion, this study suggests that the addition of CA 72-4 to CEA and/or CA 19-9 could improve sensitivity in gastric cancer. The prognostic role of this marker is not yet clearly demonstrated but its usefulness in the monitoring of gastric cancer should be taken into account.     

CA9 overexpression is an independent favorable prognostic marker in intrahepatic cholangiocarcinoma

The aim of this study is to evaluate the expression of carbonic anhydrase IX (CA9) and to identify its prognostic significance in intrahepatic cholangiocarcinoma (IHCC). We performed immunohistochemistry (IHC) for CA9 in a total of 85 IHCCs. CA9 overexpression was observed in 38 of 85 (44.7%) IHCCs. CA9 overexpression was related to tumors with intraductal growth than mass forming or periductal infiltrative type. CA9 overexpression was more observed in tumors with well/moderate differentiation than poor differentiation and without lymph node metastasis. No significant correlation was observed in CA9 overexpression with tumor size, pT, stage and lymphovascular invasion. Intrahepatic cholangiocarcinomas with CA9 overexpression showed better overall survival than that without expression (P = 0.001). In multivariate analysis, lymph node metastasis (95% CI: 2.103 (1.167-3.791), P = 0.013) was an independent poor prognostic factor. IHCC with CA9 overexpression showed a 0.5-fold (95% confidence interval, 0.328-0.944) lower risk of death compared with those of no or weak expression. CA9 overexpression was related to histologic differentiation and an independent good prognostic factor.     

High expression of matrix metalloproteinase-9 indicates poor prognosis in human hilar cholangiocarcinoma

High expression of matrix metalloproteinase-9 (MMP-9) was found to be correlated with tumor progression and poor prognosis in a variety of carcinomas. However, few studies have investigated the role of MMP-9 in human hilar cholangiocarcinoma. In this study, a total of 58 patients with hilar cholangiocarcinoma who underwent curative resection were included in this study. The expression of MMP-9 was analyzed by immunohistochemistry using the streptavidin peroxidase complex method. The correlation of MMP-9 overexpression with clinicopathological features and survival time of patients was investigated. The results showed that MMP-9 overexpression was prominent in cancer cells and mainly localized in the cytoplasm. MMP-9 overexpression was observed in 46.5% tumors, which showed no correlation with clinicopathological parameters. Patients with high MMP-9 expression had a significantly poorer overall survival rate than those with negative or low MMP-9 expression (P = 0.038). Multivariate analysis confirmed that MMP-9 overexpression was an independent prognostic factor (P = 0.007). In conclusion, overexpression of MMP-9 is a valuable independent prognostic indicator in hilar cholangiocarcinoma.     

血清TSGF的水平与结肠癌诊断及术后疗效的关系

目的 探讨肿瘤特异性生长因子（TSGF）在结肠癌诊断及术后疗效观察的价值.方法 采用比色法测定的120例结肠癌患者手术前及术后及50名对照组血清中TSGF水平,采用电化学分析的方法分别测定CEA、CA19-9水平并进行比较.结果 与结肠癌术后及对照组相比,结肠癌术前的TSGF、CEA、CA19-9水平的差异有统计学意义（P＜0.01）;结肠癌术后及对照组的TSGF、CEA、CA19-9的差异无统计学意义（P＞0.05）;术前组的TSGF、CEA、CA19-9的阳性率中,TSGF阳性率最高.结论 血清TSGF是对结肠癌的早期诊断及疗效观察具有一定的临床价值,TSGF、CEA、CA19-9三项指标的联合检测可提高对结肠癌检测的阳性率.     

Biliary brush cytology and the detection of cholangiocarcinoma in primary sclerosing cholangitis: evaluation of specific cytomorphologic features and CA19-9 levels

Interpreting biliary brush cytology (BBC) findings in primary sclerosing cholangitis (PSC) is problematic. In our study, BBC findings and CA19-9 serum levels were evaluated for their effectiveness in diagnosing cholangiocarcinoma in patients with PSC. We reviewed 107 biliary brushings from 51 patients with PSC and concurrent CA19-9 levels between January 1995 and March 2004 at the University of Washington Medical Center, Seattle. A portion of the brushings were evaluated and scored according to specific cytologic criteria; statistical analysis showed which criteria were most predictive in diagnosing malignancy: nuclear/cytoplasmic ratio, prominent nucleoli, nuclear membrane irregularities, and discohesion were significant predictive features. Sensitivity and specificity of BBC were 62.5% and 100%, respectively. Sensitivity and specificity of CA19-9 at a cutoff of 186 IU/mL were 100% and 94%, respectively. BBC is a specific and relatively sensitive method of detecting cholangiocarcinoma, even in patients with PSC, especially when certain cytomorphologic features are identified. Combining biliary cytology and CA19-9 levels might have an important diagnostic role in PSC.     

Clinical value of serum biomarkers CA153, CEA,and white blood cells in predicting sentinel lymph node metastasis of breast cancer

We retrospectively analyzed preoperative serum CA153, carcinoembryonic antigen (CEA) and white blood cells (WBC) in 121 breast cancer patients who underwent breast-conserving therapy and sentinel lymph node biopsy (SLNB) between June 2017 and April 2019 in our institution. The receiver operating characteristic curve (ROC curve) was used to determine the optional cut-offs of these biomarkers for predicting SLN metastasis. The relationship between the parameters to SLN metastasis of breast cancer was assessed by univariate analysis and multivariate logistic regression models. We finally enrolled 121 breast cancer patients who all underwent SLNB, of whom 56 were confirmed as positive SLN by histopathology. ROC curve analysis calculated an ideal CA153 cutoff value of 7.85 U/ml in prediction of SLN metastasis, with a sensitivity of 73.2%, and specificity of 67.7%. The ideal cutoff value for CEA to predict SLN metastasis was 1.66 ng/ml (sensitivity 67.9%, specificity 73.8%). CA153 combined with CEA showed specificity 78.6% and specificity 76.9%. CA153 and CEA combined with WBC presented sensitivity 80.4% and specificity 78.5%. In the multivariate logistic regression analysis, CA153 (odds ratio (OR): 1.165, 95% confidence interval (CI) 1.061-1.279, P<0.001) and CEA (OR: 3.440, 95% CI: 1.859-6.366, P<0.001) were independent predictive factors of SLN metastasis in patients with breast cancer.     

五项肿瘤标志物联合检测对食管癌诊治的临床评价

探讨肿瘤标志物癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、CA724、细胞角蛋白19片断(CYFRA21-1)和鳞状上皮细胞癌抗原(SCC)联合检测对食管癌诊断、治疗及预后判断的临床价值.用电化学发光免疫分析法(ECLIA)和微粒子酶联免疫测定法(MEIA)检测102例食管癌患者术前和90例术后血清中CEA、CA19-9、CA724、CYFRA21-1和SCC含量.102例食管癌患者血清中5项肿瘤标志物含量均明显高于对照组,随病程增加,阳性率增高.检测90例食管癌患者,术前阳性指标与术后比较,有显著性差异(P＜0.01).五项肿瘤标志物联合检测阳性率为77.5%,高于单项指标检测阳性率,有显著性差异(P＜0.01).血清CEA、CA19-9、CA724、CYFRA21-1和SCC水平动态联合监测可用于食管癌辅助诊断、疗效观察、以及对病期及预后的判断.     

肝细胞癌术后血清AFP、CA19-9、HGF水平对预后状况的影响

目的分析肝细胞癌术后血清甲胎蛋白(AFP)、糖类抗原19-9(CA19-9)、肝细胞生长因子(HGF)水平对预后状况的影响。方法将我院收入的82例肝癌患者作为研究对象,均进行根治术治疗并获得术后随访,收集其临床资料,记录其术后血清AFP、CA19-9、HGF水平,并分析其与患者预后的关系。结果复发组肿瘤直径、术后AFP、CA19-9和HGF水平均与未复发组存在差异(P<0.05);校正混杂因子后,复发组患者术后AFP、CA19-9、HGF水平与未复发组患者差异具有统计学意义(P<0.05);ROC曲线分析显示,当AFP≥167.95ng/mL、CA19-9≥42.63U/mL、HGF≥16.81μg/L时,其对应约登指数最大,预测肝细胞癌患者术后复发的灵敏度分别为86.36%、72.73%、77.27%,特异性分别为63.16%、68.42%、52.63%。术后3年无瘤生存率:术后AFP高水平组低于术后水平组(P<0.05),术后CA19-9高水平组低于术后低水平组(P<0.05),术后HGF高水平组低于术后低水平组(P<0.05)。结论肝细胞癌术后血清AFP、CA19-9、HGF水平均可预测患者术后复发情况,术后血清AFP、CA19-9、HGF水平较高的患者,预后多不理想。     

Intra-tumoral budding in preoperative biopsy specimens predicts lymph node and distant metastasis in patients with colorectal cancer

Tumor budding, a histological hallmark of epithelial-mesenchymal transition in colorectal cancer, is a parameter of tumor progression and according to the International Union Against Cancer/American Joint Committee on Cancer an 'additional' prognostic factor. The current definition of tumor budding is reserved for the invasive tumor front of colorectal cancer (so called peri-tumoral budding), but tumor buds can also be observed in small preoperative biopsy specimens. Whereas the prognostic value of peri-tumoral budding assessed in resection specimens has found wide acceptance, the value of budding in preoperative biopsies, which normally do not encompass the invasive tumor margin and hence can be called intra-tumoral budding, has not been systematically investigated yet. Therefore, the aim of this study is to assess the predictive value of intra-tumoral budding for lymph node and distant metastasis in preoperative biopsies. Preoperative biopsy samples and consecutive resection specimens from 72 patients with pathological information on TNM stage, vascular, lymphatic and perineural invasion, and tumor border configuration were used to evaluate intra-tumoral budding and peri-tumoral budding. Both parameters were scored semiquantitatively as 'high' (detectable at low power magnification × 2.5) and 'low' (occasional budding at intermediate magnification × 10, difficult to find or absent). In biopsy samples high intra-tumoral budding was observed in 12/72 patients (17%) and associated with high peri-tumoral budding in the corresponding resection specimens (P=0.008). Additionally, there was a correlation between high intra-tumoral budding and lymph node metastasis (P=0.034), distant metastasis (P=0.007) and higher tumor grade (P=0.025). Peri-tumoral budding was associated with higher N stage (P=0.004), vascular (P=0.046) and lymphatic invasion (P=0.019) as well as with an infiltrating tumor border (P<0.001), reflecting the predictive power of peri-tumoral budding for tumor progression. High intra-tumoral budding in preoperative biopsy samples of colorectal cancer patients predicts high peri-tumoral budding at the invasive margin and lymph node metastasis in the corresponding resection specimens as well as distant metastasis.     

血清肿瘤标志物CEA、CA724、CA242、CA19-9联合检测诊断肺癌的临床价值分析

目的 分析血清肿瘤标志物癌胚抗原(CEA)、糖类抗原724(CA724)、糖类抗原242(CA242)、糖类抗原19-9(CA19-9)联合检测与肺癌诊断及预后的相关性.方法 选取2014年5月至2017年1月我院收治的肺癌患者120例为研究对象,并纳入观察组,以同期入院体检的良性肺疾病患者55例为对照组,测定两组血清CEA、CA724、CA242、CA19-9水平,对比四种肿瘤标志物在不同病理类型肺癌中表达水平,分析CEA、CA724、CA242、CA19-9联合检测与单项、2联、3联检测诊断肺癌的灵敏度、特异度、准确度、阳性预测值、阴性预测值,比较CEA、CA724、CA242、CA19-9阳性或阴性患者在预后随访中无复发生存率、远处转移率.结果 观察组血清CEA(30.24±1.75)μg/L、CA724(14.85±1.11)kU/L、CA242(38.18±1.05)kU/L、CA19-9(41.24±1.57)kU/L均较对照组高(P<0.05);CEA、CA242在腺癌中表达水平最高,CA724、CA19-9在腺癌与鳞癌中表达水平差异无统计学意义(P>0.05);CEA、CA724、CA242、CA19-9联合检测诊断肺癌的灵敏度98.18%、准确度80.00%、阴性预测值80.00%,均高于上述指标单项或2联、3联检测(P<0.05);CEA、CA724、CA242、CA19-9阳性患者与阴性患者比较,无复发生存率明显较低,远处转移率显著较高(P<0.05).结论 血清肿瘤标志物CEA、CA724、CA242、CA19-9联合检测诊断肺癌的灵敏度、准确度较单项、2联及3联检测明显提高,且上述指标可用于预测预后,值得在临床推广应用.     

骨形成蛋白3在肝门部胆管癌组织中的表达及其临床意义

目的:探讨肝门部胆管癌组织中骨形成蛋白3(BMP3)的表达情况及其临床意义。方法:收集30例肝门部胆管癌的临床标本,应用real-time PCR和Western blot检测BMP3 mRNA和蛋白在癌组织和癌旁组织的相对表达情况。收集103例肝门部胆管癌石蜡标本,免疫组织化学法检测肿瘤组织中BMP3蛋白的表达,并分析其与临床病理的关系。结果:全组30例肝门部胆管癌组织中,22例癌组织BMP3蛋白和mRNA的表达水平较癌旁组织明显下降。免疫组织化学方法显示103例肝门部胆管癌组织中,87例阴性,16例弱阳性,BMP3蛋白的表达与肿瘤TNM分期、淋巴结转移、肿瘤的分化程度密切相关(P0.05)。结论:肝门部胆管癌组织中BMP3基因处于抑制状态,其表达的下调可能与肝门部胆管癌的发生、发展密切相关。     

Urinary bladder urothelial carcinoma with concurrent plasmacytoid and micropapillary differentiations: A report of two cases with an emphasis on serum carbohydrate antigen 19‐9

We report two cases of urinary bladder urothelial carcinoma (UC). In both, histological examination of a transurethral resection specimen of the bladder tumor revealed UC with plasmacytoid and micropapillary differentiations. In Case 1, residual plasmacytoid UC deeply invaded the extravesical fat tissue of the radical cystectomy specimen, and metastatic carcinoma was found in almost all the dissected lymph nodes. Despite adjuvant chemotherapy and radiotherapy, the patient died 25 months postdiagnosis. Elevated serum carbohydrate antigen 19‐9 (CA19‐9) returned to near normal levels after radical cystectomy, but they increased shortly before death. In Case 2, no residual carcinoma was found in the radical cystectomy specimen or lymph nodes. Postoperative serum CA19‐9 was maintained at normal levels, and the patient remains alive without recurrence or metastasis. Although plasmacytoid and micropapillary UC are known aggressive variants of UC, plasmacytoid UC may be more aggressive. Serum CA19‐9 could serve as a useful biomarker to monitor progression of plasmacytoid UC.     

螺旋CT结合CA19-9在胰腺癌可切除性评价中的应用

目的 探索螺旋CT双期扫描与CA19-9检测相结合在胰腺癌术前可切除性评价中的应用价值. 方法 回顾分析2002年2月至2006年2月本院52例胰腺癌患者的临床资料,根据螺旋CT双期扫描结果和血清CA19-9检测结果进行胰腺癌术前可切除性评价. 结果 CT判断胰腺癌不可切除的准确率为100%,而判断可切除的准确率为73.30%.随着胰腺癌浸润程度的进展,CA19-9水平有增高的趋势.局部侵犯组CA19-9均值与可切除组和转移组CA19-9均值差异无统计学意义.以CA19-9大于150 U/ml作为不可切除判断的临界值,在不可切除组41例患者中,只有10例患者的血清CA19-9水平大于150 U/ml,占24.39%. 结论 血清CA19-9水平随胰腺癌浸润进展程度有逐渐升高的趋势,但CA19-9水平并不能反应胰周大血管受侵犯.CA19-9检测与CT结合在胰腺癌术前可切除性评价中的临床实用价值有限.     

CA19-9、增强MRI和PET/CT在胰腺癌诊断及分期中的价值

目的探讨CA19-9、增强MRI和PET/CT在胰腺癌诊断及分期中的价值。方法回顾性分析沈阳军区总医院普外科2013年1月至2014年1月间收治的92例手术治疗的胰腺占位患者资料。患者术前均行CA19-9检查、腹部增强MRI扫描及全身PET/CT扫描,以术后病理或临床综合评价诊断为标准,比较CA19-9、增强MRI和PET/CT在胰腺癌诊断及分期中的价值。结果 92例患者中,确诊胰腺癌82例,非胰腺癌10例。CA19-9检查、腹部增强MRI及全身PET/CT对胰腺癌诊断的灵敏度分别为78.0%、86.6%和92.7%。PET/CT具有较高灵敏度,显著优于CA19-9,差异有统计学意义（P=0.008）;PET/CT优于增强MRI,差异无统计学意义（P=0.200）;在胰周淋巴结转移判断方面,增强MRI和PET/CT的灵敏度分别为46.9%、81.6%,二者差异有统计学意义（P〈0.001）;在肝转移判断方面,增强MRI和PET/CT诊断的灵敏度分别为54.5%、72.7%,二者差异无统计学意义（P=0.66）。结论PET/CT对胰腺癌诊断有较高灵敏度,优于CA19-9、增强MRI;PET/CT有助于发现淋巴结和远处器官转移病灶,获得更加准确的术前分期,从而避免诊断性剖腹探查手术。由于仍然存在假阴性、假阳性,应该综合其他检查方法对疾病作全面分析来提高临床诊断准确性。