血清CA19-9预测吉西他滨化疗的晚期胰腺癌患者的预后

目的：将晚期胰腺癌化疗前后血清癌抗原19-9（CA19-9）变化水平与其影像学客观反应和临床受益反应进行比较,以探讨与预后关系最密切的因素。方法：比较血清CA19-9下降水平与影像学客观反应和临床受益反应作为判定晚期胰腺癌患者接受吉西他滨单药或以其为基础的联合方案化疗后生存期的差异。结果：所有64例患者的中位生存期（median survival time,MST）为7.0个月。血清CA19-9基线水平小于中位值（928.6ng/ml）患者的生存期明显长于其水平大于中位值者（9.4个月vs 4.2个月,P〈0.001）血清CA19-9下降水平与MST和疾病无进展（non-progression disease,NPD）及临床受益反应（clinical benefit response,CBR）密切相关,化疗2周期后血清CA19-9下降水平≥25%的MST明显长于其水平下降〈25%者（8.9个月vs 4.4个月,P〈0.001）。影像学疾病无进展（NPD）和临床受益（CBR）均与MST密切相关,NPD患者的MST明显长于疾病进展者（8.8个月vs 7.4个月,P=0.022）;CBR患者的MST明显长于非CBR者（9.1个月vs 6.2个月,P=0.022）。多因素分析显示,血清CA19-9基线水平的中位值和血清CA19-9下降水平≥25%是影响预后的独立因素生存期密切相关,而NPD和CBR与预后无关。结论：与影像学客观反应和临床受益反应相比,血清CA19-9下降水平能更有力地预测预后生存期。血清CA19-9下降水平是指导临床治疗晚期胰腺癌较合理的指标。     

经动脉持续灌注化疗治疗中晚期胰腺癌的临床分析

 目的 比较经动脉持续灌注化疗和全身静脉化疗治疗中晚期胰腺癌的临床疗效，探讨选择性动脉持续灌注化疗的临床应用价值。方法 51例中晚期胰腺癌，其中25例采用经动脉持续灌注吉西他滨和5-Fu方案，26例采用经外周静脉灌注吉西他滨和5-Fu方案。应用世界卫生组织实体瘤疗效评定标准评价疗效，肿瘤体积测量采用MRI或CT。使用临床受益反应（CBR）对疼痛、体力状况及体重改变情况作出综合评价。采用WH0抗肿瘤药物急性与亚急性毒性分级标准对不良反应进行评价。结果 动脉灌注化疗组的有效率（32．0％）高于外周静脉化疗组（23．1％），但差异无显著性。动脉灌注化疗组的临床受益率（80．0%）高于外周静脉化疗组（50．0％），差异有显著性。6个月、9个月、1年的累积生存率和中位生存时间，动脉灌注化疗组高于外周静脉化疗组，差异有显著性。按WHO分级标准，两组患者不良反应之间无显著性的差异。结论 经动脉持续灌注吉西他滨和5-Fu较外周静脉灌注吉西他滨和5-Fu能提高中晚期胰腺癌的临床受益率和生存期，其方法安全可靠，且不良反应少。     

血清CA19-9预测吉西他滨化疗的晚期胰腺癌患者的预后

目的:将晚期胰腺癌化疗前后血清癌抗原19-9(CA19-9)变化水平与其影像学客观反应和临床受益反应进行比较,以探讨与预后关系最密切的因素。方法:比较血清CA19-9下降水平与影像学客观反应和临床受益反应作为判定晚期胰腺癌患者接受吉西他滨单药或以其为基础的联合方案化疗后生存期的差异。结果:所有64例患者的中位生存期(median survival time,MST)为7.0个月。血清CA19-9基线水平小于中位值(928.6ng/ml)患者的生存期明显长于其水平大于中位值者(9.4个月vs 4.2个月,P<0.001)血清CA19-9下降水平与MST和疾病无进展(non-progression disease,NPD)及临床受益反应(clinical benefit response,CBR)密切相关,化疗2周期后血清CA19-9下降水平≥25%的MST明显长于其水平下降<25%者(8.9个月vs 4.4个月,P<0.001)。影像学疾病无进展(NPD)和临床受益(CBR)均与MST密切相关,NPD患者的MST明显长于疾病进展者(8.8个月vs 7.4个月,P=0.022);CBR患者的MST明显长于非CBR者(9.1个月vs 6.2个月,P=0.022)。多因素分析显示,血清CA19-9基线水平的中位值和血清CA19-9下降水平≥25%是影响预后的独立因素生存期密切相关,而NPD和CBR与预后无关。结论:与影像学客观反应和临床受益反应相比,血清CA19-9下降水平能更有力地预测预后生存期。血清CA19-9下降水平是指导临床治疗晚期胰腺癌较合理的指标。     

吉西他滨联合适形放疗与吉西他滨联合顺铂对局部晚期胰腺癌的疗效比较

目的：比较吉西他滨联合适形放疗与吉西他滨联合顺铂对局部晚期胰腺癌的疗效。方法：前瞻性分析了2002年3月-2005年8月收治的56例局部晚期胰腺癌患者的疗效，其中26例采用吉西他滨联合适形放疗（放化组），30例采用吉西他滨联合顺铂（化疗组）。结果：可评估病例54例，放化组有效率（CR＋PR）为68．O％，化疗组有效率（CR＋PR）为37．9％，两组差异有统计学意义（P=0．0275）。放化组和化疗组的6月生存率分别为84．O％和62．1％（P=0．0728）；12月生存率分别为64．O％和37．9％（P=0．0561）。两组差异无统计学意义。放化组和化疗组的临床获益率（CBR）分别为84．0％和69．0％，两者差异无统计学意义（P=0．1976）。放化组和化疗组的严重不良事件总发生率分别为36．0％和44．8％，无统计学差异（P=0．5103）。结论：在近期疗效方面，吉西他滨联合适形放疗的近期疗效优于吉西他滨联合顺铂；而远期生存率，吉西他滨联合适形放疗虽然显示出一定的优势，但无统计学意义，二者在CBR和严重不良事件发生率无明显差异。     

三维适形放疗同步国产吉西他滨化疗治疗局部晚期胰腺癌

背景与目的：综合治疗肿瘤是目前的趋势，三维适形放射治疗（3D—CRT）是较新的放疗技术，本文观察：维适形放射治疗（3D—CRT）联合国产吉西他滨化疗治疗局部晚期胰腺癌的耐受性及疗效。方法：36例局部晚期胰腺癌患者进入三维适形放射治疗联合吉西他滨化疗组，全部患者均行吉西他滨化疗，方案为每周1次吉西他滨250mg／m^2.36例患者分别完成3～7个周期的化疗。同步行3D—CRT，计划照射剂量8MV—X线DT65～70Gy．2～2．5Gy／次，1次／天，5天／N结果：36例患者全部完成治疗计划，胰腺痛原发灶完全缓解率（CR）为2．8％（1／36），部分缓解率（PR）为27．8％（10／36），总有效率（CR＋PR）为30．6％（11／36），无变化和进展（NC＋PD）占69．4％（25／36），白细胞下降发生率为91．7％（33／36）疼痛缓解率为90．3％。36例患者的中位随访期为24（12～29）个月。1年及2年生存率分别为36．1％（13／36）和19．4％（7／36）结论：三维适形放射治疗同步吉西他滨化疗治疗局部晚期胰腺癌疗效较好，能明显提高患者的生活质量和生存期，不良反应能为大多数患者耐受，是治疗局部晚期胰腺癌的较好方法。     

白蛋白结合型紫杉醇治疗吉西他滨一线化疗失败后晚期胰腺癌的临床观察

目的 观察和评价白蛋白结合型紫杉醇（Nab-P）治疗吉西他滨一线化疗失败后晚期胰腺癌的疗效和安全性。方法 回顾分析2012年5月至2015年5月接受Nab-P单药或联合方案（Nab-P 110 mg／m2静滴,第1、8天,21天为1周期）作为二线或二线以上治疗的晚期胰腺癌患者。分别采用RECIST 1.1版与NCI-CTC 4.0版标准评价近期疗效和毒副反应。采用Kaplan-Meier法进行生存分析。结果 共纳入13例患者,其中9例可评价疗效和毒副反应。9例患者平均年龄为56.1岁,Nab-P 平均治疗2.27个周期。9例患者的疾病控制率（DCR）为55.6％,其中2例获PR,3例SD,4例PD;CA199较基线下降50％者4例（44.4％）;中位疾病进展时间（TTP）为3.3个月（95％CI：2.4～4.2个月）,中位生存时间（OS）为14.2个月（95％CI：2.8～25.6个月）;3个月及6个月生存率分为88.9％和77.8％。常见毒副反应多为1～2级,主要为白细胞减少、中性粒细胞减少、乏力、恶心、呕吐等。结论 Nab-P对国人吉西他滨一线治疗失败后的晚期胰腺癌具有较好的疗效,且耐受性良好。     

外周血内CA19-9、CA242及CEA对胰腺癌诊断及病理分期评估的价值

目的：分析糖类抗原19-9（carbohydrate antigen 19-9,CA19-9）、CA242、癌胚抗原（carcino-embryonic anti-gen,CEA）联合检测诊断胰腺癌的临床价值及其对临床分期判断的指导作用。方法选取95例胰腺癌患者为患者组,及同期60例健康体检者为对照组,比较两组受试者血清CA19-9、CA242和CEA的表达水平,计算血清CA19-9、CA242、CEA单独检测及联合检测诊断胰腺癌的敏感度、特异度和准确性,并比较不同临床分期胰腺癌患者血清CA19-9、CA242、CEA的差异,评价上述指标对胰腺癌临床分期判断的指导作用。结果患者组血清 CA19-9、CA242、CEA水平均高于对照组,差异均具有统计学意义（均P＜0．05）。联合检测诊断胰腺癌的敏感度、特异度和准确性分别为96．8％、66．7％、85．2％,其敏感度、准确性均优于单项检测。随着患者病理分期的增加,其血清CA19-9、CA242、CEA水平均升高,差异均具有统计学意义（均P＜0．05）。患者组治疗后6个月血清CA19-9、CA242、CEA水平均较术前降低,差异均具有统计学意义（均P＜0．05）。肿瘤直径≥5 cm者、肿瘤位于胰腺体／尾部者,其血清CA19-9、CA242、CEA水平均高于肿瘤直径＜5 cm 者及肿瘤位于胰腺头部或全胰腺者,差异均具有统计学意义（均 P＜0.05）。结论联合检测血清CA19-9、CA242和CEA有助于胰腺癌的早期诊断及分期判断,具有较高的临床价值。     

白蛋白紫杉醇二线治疗晚期胰腺癌的临床观察

目的:探讨白蛋白紫杉醇二线治疗一线含吉西他滨方案化疗失败的晚期胰腺癌患者的疗效和安全性。方法:6例一线含吉西他滨方案化疗失败的晚期胰腺癌患者,给予白蛋白紫杉醇100mg/m2 静脉滴注,d1、d8、d15,28天为1周期。治疗至疾病进展或出现不可耐受的不良反应。根据实体瘤疗效反应评价标准(RECIST)评价疗效,常规毒性判定标准(NCI-CTC 3.0)评价不良反应。结果:6例患者中位治疗时间为2周期（1~8周期）,无CR病例,PR 1例,SD 3例,PD 2例。总有效率为16.7%,疾病控制率为66.7%,中位无疾病进展时间（PFS）为5.3个月,中位总生存时间（OS）为7个月,有2例患者仍存活,随访至今,生存时间分别为54个月和58个月。不良反应主要为骨髓抑制和神经毒性,多为Ⅰ-Ⅱ级,其中1例患者出现Ⅲ级白细胞下降,4例Ⅱ级下降;2例出现Ⅱ级肌肉酸痛,无Ⅳ级不良反应。结论:对于一线含吉西他滨方案化疗失败的晚期胰腺癌患者,白蛋白紫杉醇单药方案化疗可取得一定疗效,患者耐受性好,值得扩大样本量进一步研究。     

经动脉药盒输注吉西他滨治疗37例晚期胰腺癌

目的：评价经动脉药盒输注吉西他滨对未经其他治疗的晚期胰腺癌的疗效。方法：57例均经手术探查未能切除并经病理证实为胰腺癌患者，采用介入的方法植入德国贝朗公司的Implantofix药盒，9例经左锁骨下动脉将药盒植入于左胸壁皮下，48例经右股动脉将药盒植入于右下腹股沟部。治疗组首次疗程总量分3次注入吉西他滨3.0g，氟尿嘧啶3.0g，白细胞介素－2600万U。对照组仅不输注吉西他滨。结果：57例介入药盒均植入成功，留置管通畅率达100％，留置管滑脱率为0％，2例老年肥胖女性患者右腹股沟部切口愈合不良而于术后2个月拔除药盒。57例按照胰腺癌患者临床受益反应的评价标准，分为治疗组（37例）、对照组（20例）。本研究主要疗效评估指标（临床受益反应）治疗组比对照组有效。27．2％的治疗组患者获疼痛程度、止痛剂用量的显著而持久的改善，而对照组为4.8%(P=0.0022)。临床受益反应持续时间治疗组18周，对照组13周。治疗组的中位生存期6.25个月，对照组为4.41个月，具有统计学意义（P＝0．0025）。治疗组6个月、9个月及12个月的生存率分别为46％、24％和18％，高于对照组的31％、6％和2％。结论：经动脉药盒输注吉西他滨对晚期胰腺癌有明显的缓解疼痛、延长生存期的作用，并为晚期患者提供了长期动脉内化疗灌注的良好、有效的途径。     

吉西他滨单药及联合用药治疗晚期胰腺癌的疗效对比:一项针对Ⅲ期随机对照临床试验的荟萃分析

背景与目的：晚期胰腺癌的治疗效果较差，生存期也较短。吉西他滨是治疗晚期胰腺癌的一线药物，有研究表明吉西他滨联合用药对患者的生存有益。本研究通过荟萃分析对比吉西他滨单药和联合用药在治疗晚期胰腺癌中的疗效。方法：检索MEDLINE、EBMreviews、EMBASE等数据库，查阅有关文献。所选Ⅲ期随机对照试验的研究对象为晚期胰腺癌，单药治疗组接受吉西他滨单药化疗，联合治疗组接受吉西他滨联合（铂类、喜树碱类，抗代谢素或靶向类）药物治疗。两名评价员独立检索资料。评价指标包括6个月、1年生存率及ORR（客观缓解率）等。结果：共检索出19篇符合要求的文章。荟萃分析结果显示联合治疗组1年生存率较单药治疗组高，两组间差异有显著性（RR：0．87，95％可信区间：[0．78，0．96]，P=0．008）。结论：吉西他滨联合用药可能有效提高晚期胰腺癌患者的生存率。     

肿瘤标记物CA19-9、CA242对胰腺癌转移和预后预测价值的分析

目的:探讨肿瘤标记物糖类抗原19-9(CA19-9)、糖类抗原242(CA242)对胰腺癌转移和预后的预测价值.方法:选取80例胰腺癌患者和20例健康人群的血清样本,测定血清中CA19-9、CA242水平.探讨两者与胰腺癌临床分期、分型、肿瘤大小、淋巴转移情况和预后的关系.结果:胰腺癌患者血清CA19-9、CA242水平显著高于健康人群(P＜0.01).胰腺癌患者中Ⅲ+ Ⅳ期患者血清CA19-9、CA242水平显著高于Ⅰ+Ⅱ期患者(P＜0.05),淋巴转移患者血清CA19-9、CA242水平显著高于无转移患者(P＜0.05),生存期小于8个月患者血清CA19-9、CA242水平显著高于大于8个月患者(P＜0.05).以CA19-9 37.0U/ml、CA242 20.0U/ml为阳性阈值,以CA19-9阳性且CA242阳性组的正确指数最高.结论:胰腺癌患者血清CA19-9、CA242水平对胰腺癌患者术前诊断和预后分析具有一定参考价值.     

Applicative Value of Serum CA19-9, CEA,CA125 and CA242 in Diagnosis and Prognosis for Patients with Pancreatic Cancer Treated by Concurrent Chemoradiotherapy

Objective: To evaluate the application value of serum CA19-9, CEA, CA125 and CA242 in diagnosis andprognosis of pancreatic cancer cases treated with concurrent chemotherapy. Materials and Methods: 52patients with pancreatic cancer, 40 with benign pancreatic diseases and 40 healthy people were selected. Theelectrochemiluminescence immunoassay method was used for detecting levels of CA19-9, CEA and CA125, anda CanAg CA242 enzyme linked immunoassay kit for assessing the level of CA242. The Kaplan-Meier methodwas used for analyzing the prognostic factors of patients with pancreatic cancer. The Cox proportional hazardmodel was applied for analyzing the hazard ratio (HR) and 95% confidential interval (CI) for survival timeof patients with pancreatic cancer. Results: The levels of serum CA19-9, CEA, CA125 and CA242 in patientswith pancreatic cancer were significantly higher than those in patients with benign pancreatic diseases andhealthy people (P<0.001). The sensitivity of CA19-9 was the highest among these, followed by CA242, CA125and CEA. The specificity of CA242 is the highest, followed by CA125, CEA and CA19-9. The sensitivity andspecificity of joint detection of serum CA19-9, CEA, CA125and CA242 were 90.4% and 93.8%, obviouslyhigher than single detection of those markers in diagnosis of pancreatic cancer. The median survival time of52 patients with pancreatic cancer was 10 months (95% CI7.389~12.611).. Patients with the increasing level ofserum CA19-9, CEA, CA125, CA242 had shorter survival times (P=0.047. 0.043, 0.0041, 0.029). COX regressionanalysis showed that CA19-9 was an independent prognostic factor for patients with pancreatic cancer (P=0.001,95%CI 2.591~38.243). Conclusions: The detection of serum tumor markers (CA19.9, CEA, CA125 and CA242)is conducive to the early diagnosis of pancreatic cancer and joint detection of tumor markers helps improve thediagnostic efficiency. Moreover, CA19-9 is an independent prognostic factor for patients with pancreatic cancer.     

The clinical value of serum CEA, CA19-9, and CA242 in the diagnosis and prognosis of pancreatic cancer.

AIM: Serum tumour markers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and CA242 were investigated to evaluate the values of single and combined test in the diagnosis and prognosis of pancreatic cancer. METHODS: Pre-operative serum CEA, CA19-9 and CA242 were measured in 105 pancreatic cancers, 70 non-pancreatic malignancies and 30 benign pancreatic diseases. RESULTS: The sensitivity of CA19-9 alone was the highest in pancreatic cancer patients (80%), but the specificity was significantly lower than that of CEA and CA242 (P<0.01). The combination of CEA and CA242 could increase the specificity to 92%. In serum CA242 positive patients, the survival time was remarkably shorter than that of patients with negative result (P<0.01). The survival time in patients with more than two markers positive expression of CEA, CA19-9 and CA242 was obviously shorter than that of only one or no marker positive expression (P<0.05). CONCLUSION: The diagnostic rate of CA19-9 in pancreatic cancer is better than that of CEA and CA242. Combined detection of CEA and CA242 can improve the diagnostic specificity obviously. High levels of serum markers are associated with advanced stage of the disease. Patients with two or three markers positive expression of CEA, CA19-9, and CA242 simultaneously had a shorter survival time.     

Serum diagnosis of pancreatic adenocarcinoma using surface-enhanced laser desorption and ionization mass spectrometry.

PURPOSE: Each year in the United States, approximately 30,000 people die from pancreatic cancer. Fewer than 5% of patients survive >5 years after diagnosis, because most patients present with advanced disease. Early diagnosis may improve the prognosis of patients with pancreatic cancer. EXPERIMENTAL DESIGN: In an attempt to improve on current approaches to the serological diagnosis of pancreatic cancer, we analyzed serum samples from patients with and without pancreatic cancer using surface-enhanced laser desorption and ionization (SELDI) protein chip mass spectrometry. Using a case-control study design, serum samples from 60 patients with resectable pancreatic adenocarcinoma were compared with samples from 60 age- and sex-matched patients with nonmalignant pancreatic diseases, as well as 60 age- and sex-matched healthy controls. To increase the number of proteins potentially identifiable, serum was fractionated using anion exchange and profiled on two ProteinChip surfaces (metal affinity capture and weak cation exchange). RESULTS: We determined a minimum set of protein peaks able to discriminate between patient groups and used the unified maximum separability algorithm to compare the performance of the individual marker panels alone or in conjunction with CA19-9. Among the peaks identified by SELDI profiling that had the ability to distinguish between patient groups, the 2 most discriminating protein peaks could differentiate patients with pancreatic cancer from healthy controls with a sensitivity of 78% and specificity of 97%. These 2 markers performed significantly better than the current standard serum marker, CA19-9 (P < 0.05). The diagnostic accuracy of the 2 markers was improved by using them in combination with CA 19-9. Similarly, a combination of 3 SELDI markers and CA19-9 was superior to CA19-9 alone in distinguishing individuals with pancreatic cancer from the combined pancreatic disease controls and healthy subject groups (P = 0.078). SELDI markers were also better than CA19-9 in distinguishing patients with pancreatic cancer from those with pancreatitis. CONCLUSION: SELDI profiling of serum can be used to accurately differentiate patients with pancreatic cancer from those with other pancreatic diseases and from healthy controls.     

Tumor markers in pancreatic cancer: a European Group on Tumor Markers (EGTM) status report

Pancreatic ductal adenocarcinoma is one of the most difficult malignancies to diagnose and treat. The aim of this article is to review how tumor markers can aid the diagnosis and management of patients with this malignancy. The most widely used and best validated marker for pancreatic cancer is CA 19-9. Inadequate sensitivity and specificity limit the use of CA 19-9 in the early diagnosis of pancreatic cancer. In non-jaundiced patients, however, CA 19-9 may complement other diagnostic procedures. In patients with resectable pancreatic cancer, presurgical and postresection CA 19-9 levels correlate with overall survival. In advanced disease, elevated pretreatment levels of CA 19-9 are associated with adverse patient outcome and thus may be combined with other factors for risk stratification. Most, but not all, reports indicate that serial levels of CA 19-9 correlate with response to systemic therapy. Use of CA 19-9 kinetics in conjunction with imaging is therefore recommended in monitoring therapy. Although several potential serum and tissue markers for pancreatic cancer are currently undergoing evaluation, none are sufficiently validated for routine clinical use. CA 19-9 thus remains the serum pancreatic cancer marker against which new markers for this malignancy should be judged.     

外周血内CA19-9、CA242、CEA检测对不同病理分期胰腺癌的临床诊断价值

目的:分析糖类抗原19-9、糖类抗原242、癌胚抗原(CEA)检测对不同病理分期胰腺癌的临床诊断价值。方法:选取我院2015年7月至2017年1月收治的106例胰腺癌患者,检测血清CA19-9、CA242、CEA表达水平,比较手术治疗前后及不同临床分期胰腺癌患者血清CA19-9、CA242、CEA差异,评价上述指标对胰腺癌临床诊断及判断分期的指导作用。结果:胰腺癌病理分期越高,其血清CA19-9、CA242、CEA水平升高越显著,差异有统计学意义（P＜0.05）。肿瘤直径≥5 cm者、肿瘤位于胰腺体/尾部者,其血清CA19-9、CA242、CEA均显著高于肿瘤直径＜5 cm者及肿瘤位于胰腺头部或全胰腺者,差异有统计学意义（P＜0.05）。 结论:血清CA19-9、CA242、CEA有助于胰腺癌的临床诊断及分期判断,具有较高的临床价值。     

The clinical utility of serum CA 19-9 in the diagnosis,prognosis and management of pancreatic adenocarcinoma: An evidence based appraisal

Background

Serum carbohydrate antigen (CA 19-9) is the most common tumor marker assessed in pancreatic cancer patients; nevertheless few articles have comprehensively evaluated the evidence for its utility in pancreatic cancer management.

Methods

Literature search was performed using Medline with keywords "pancreatic cancer", "tumor markers", "CA 19-9", "diagnosis", "screening", "prognosis", "resectability" and "recurrence". All English language articles pertaining to the role of CA 19-9 in pancreatic cancer were critically analyzed to determine its utility as a biomarker for pancreatic cancer.

Results

Serum CA 19-9 is the most extensively validated pancreatic cancer biomarker with multiple clinical applications. CA 19-9 serum levels have a sensitivity and specificity of 79-81% and 82-90% respectively for the diagnosis of pancreatic cancer in symptomatic patients; but are not useful as a screening marker because of low positive predictive value (0.5-0.9%). Pre-operative CA 19-9 serum levels provide useful prognostic information as patients with normal levels (<37 U/mL) have a prolonged median survival (32-36 months) compared to patients with elevated levels (>37 U/mL) (12-15 months). A CA 19-9 serum level of <100 U/mL implies likely resectable disease whereas levels >100 U/mL suggest unresectablity or metastatic disease. Normalization or a decrease in post-operative CA 19-9 serum levels by ≥20-50% from baseline following surgical resection or chemotherapy is associated with prolonged survival compared to failure of CA 19-9 serum levels to normalize or an increase. Important limitations to CA 19-9 serum level evaluation in pancreatic cancer include poor sensitivity, false negative results in Lewis negative phenotype (5-10%) and increased false positivity in the presence of obstructive jaundice (10-60%).

Conclusions

CA 19-9 is the most extensively studied and validated serum biomarker for the diagnosis of pancreatic cancer in symptomatic patients. CA 19-9 serum levels can provide important information with regards to prognosis, overall survival, and response to chemotherapy as well as predict post-operative recurrence. However, non-specific expression in several benign and malignant diseases, false negative results in Lewis negative genotype and an increased false positive results in the presence of obstructive jaundice severely limit the universal applicability of serum CA 19-9 levels in pancreatic cancer management.Key Words : Pancreatic cancer, tumor markers, CA 19-9, diagnosis, screening, prognosis, resectability, recurrence     

Can Serum ICAM 1 Distinguish Pancreatic Cancer from Chronic Pancreatitis?

Background and aim: Pancreatic cancer is the fourth leading cause of cancer-related death worldwide, with an overall 5-year survival of <5% mainly due to presence of advanced disease at time of diagnosis. Therefore development of valid biomarkers to diagnose pancreatic cancer in early stages is an urgent need. This study concerned the sensitivity and specificity of serum ICAM 1 versus CA 19-9 in differentiation between pancreatic cancer and healthy subjects and acohort of patients with chronic pancreatitis with a focus on assessing validity in diagnosis of early stages of pancreatic cancer. Methods: A cohort of 50 patients with histologically diagnosed pancreatic tumors, 27 patients with chronic pancreatitis, and 35 healthy controls were enrolled. Serum samples for measurement of CA19-9 and I-CAM 1 were obtained from all groups and analyzed for significance regarding diagnosis and disease stage. Results: At a cut off value of (878.5 u/ml) I-CAM 1 had 82% and 82.26% sensitivity and specificity for differentiation between cancer and non-cancer cases, with higher sensitivity and specificity than CA19-9 at different cut offs (CA19-9 sensitivity and specificity ranged from 64-80% and 56.4 – 61.2% respectively). The AUC was 0.851 for I-CAM and 0.754 for CA19-9. Neither of the markers demonstrated significance for distinguishing between early and late cancer stages. Conclusion: ICAM 1 is a useful marker in differentiation between malignant and benign pancreatic conditions, and superior to CA19-9 in this regard. However, neither of the markers can be recommended for use in differentiation between early and late stage pancreatic cancers.