胰腺肿块伴黄疸对肿瘤标志物诊断的影响分析

目的 评价有无黄疸在肿瘤标志物对胰腺良恶性占位中的意义.方法 对60例胰腺恶性肿瘤及19例良性占位患者,利用美国雅培公司化学发光分析仪器及配套试剂进行测定血CA199、CA125和CEA含量,分析比较其单项及联合诊断的敏感度和特异度、ROC曲线分析及组间比较分析.结果 (1)单项指标检测以CA199诊断价值最大,敏感度和特异度分别为66.7%、78.9%,误诊率22.1%,漏诊率33.3%(约登指数＝0.456);两者联合中,CA199+CEA组敏感度和特异度分别为73.3%、73.7%,误诊率26.7%,漏诊率26.3%,联合诊断价值最高(约登指数＝0.470);优于CA199等单项指标组,差异具有统计学意义(P<0.05);而三者联合诊断并不优于CA199或CA199+CEA联合诊断.(2)胰腺良性占位组中,CA199等在黄疸或不伴黄疸组表达无统计学差异(P>0.05);而在胰腺恶性肿块患者中,黄疸组与无黄疸组相比,非参数检验结果为CA199(Z=1.063,P=0.020)、CA125(Z=0.067,P=0.947)、CEA(Z=0.502,P=0.616),黄疸对CA199水平影响差异有统计学意义(P<0.05),而对CA125、CEA等影响,统计分析显示均无统计学差异(P>0.05).结论 对于胰腺肿瘤的诊断,CA199+CEA联合诊断价值最高,优于CA199等单项指标组及三者联合组.CA199在对伴有黄疸的胰腺良恶性疾病的鉴别,除考虑其肿瘤标志物外还要考虑黄疸的影响作用,将来通过ROC曲线等研究CA199调定点的不同,有望达到更优的诊断效能.另外胰腺癌伴有胆红素异常患者是否为胰腺癌一个独特亚型,有待进一步临床证实.     

血清标记物Elastase 1和胰腺疾病

胰腺疾病如胰腺炎、胰腺癌和胰腺囊肿等常缺乏特异的临床表现,误诊漏诊率较高.其中胰腺癌早期诊断更是困难,患者获得诊断时常常已处于肿瘤晚期,错过了最佳治疗时机.为了提高胰腺癌的诊断水平,人们在肿瘤血清标记物方面作了大量的工作.其中某些标记物如CA19-9,CEA和CA50等已经广泛用于临床并为人们所熟知.下面仅就另外一种标记物,即弹力蛋白酶1(elastase 1)在胰腺疾病,尤其是胰腺癌诊断中的应用做一简要综述.     

CEA、CA19-9、CA50联合检测在肝门部胆管癌诊断中的意义

采用放射免疫法和免疫放射法对44例肝门胆管癌患者和40例胆管良性疾病患者静脉血清中CEA、CA19-9和CA50进行测定.发现诊断胆管癌血清CA19-9、CA50的灵敏度较好(82.6%、71.7%),血清CEA的特异度最好(85.0%),联合检测灵敏度下降至69.6%,其误诊率下降为5%.提示联合检测肿瘤标志物对肝门胆管癌的诊断具有协同作用,准确度增加,降低了误诊率.     

血清CA125、CEA、AFP联检对卵巢肿瘤的诊断价值

目的探讨联检血清肿瘤标记物CA125、癌胚抗原(CEA)、甲胎蛋白(AFP)在诊断卵巢良、恶性肿瘤及判定其预后的意义.方法采用化学发光免疫法检测132例卵巢肿瘤患者(良性79例,恶性53例)手术前后血清CA125、CEA、AFP水平,同时随机检测51例正常查体者血清CA125、CEA、AFP作为对照.结果卵巢恶性肿瘤患者血清CA125、CEA、AFP水平与良性肿瘤及对照组比较,均有显著性差异(P<0.01);良性肿瘤与正常对照者之间无显著性差异(P>0.05);卵巢恶性肿瘤患者术前与术后化疗3个疗程后血清CA125、CEA、AFP比较,差异显著(P<0.01).结论联检肿瘤标记物CA125、CEA、AFP是鉴别卵巢良、恶性肿瘤,早期诊断卵巢癌的有效方法之一 .     

肿瘤标志物检测在胰腺癌诊断和预后评估中的价值研究

目的评价胰腺癌肿瘤标志物对胰腺癌诊断及预后的影响。方法收集2007年1月至2011年12月沈阳军区总医院胰腺癌住院患者198例,良性胰腺病50例,正常对照组61名。采用放射免疫分析法检测血清肿瘤标志物CA19-9、CA242、CA50、CA125、CEA。分析回访到生存期的120例胰腺癌患者预后影响因素。结果胰腺癌患者肿瘤标志物CA19-9、CA242、CA125明显增高,与正常对照组及良性胰腺病变组比较差异有统计学意义(P0.05);CA19-9、CA242、CA125、CA50和CEA灵敏度分别为80.84%、72.50%、56.67%、56.12%、45.31%,特异度分别为76.80%、69.32%、72.96%、65.33%、57.40%。联合检测灵敏度有提高,但特异度降低。胰腺癌患者中位生存期5.5个月,胰体尾癌及全胰腺癌较胰头癌生存期短,CA19-9、CA242、CA125升高的患者生存期短(P0.05)。多因素Cox比例风险回归分析显示,CA19-9、CA242是独立预后因素(P0.05)。结论胰腺癌血清肿瘤标志物检测有助于胰腺癌的早期诊断。联合检测肿瘤标志物有助于提高对胰腺癌的诊断效率,胰腺体尾部肿瘤、CA19-9、CA242、CA125升高的患者生存期短。CA19-9、CA242是胰腺癌的独立预后因素,有助于评估预后。     

胃肠道恶性肿瘤的醣抗原决定簇(CA19-9)和其他肿瘤标志

恶性肿瘤的肿瘤标志可以是癌胚、组织相关抗原、激素或酶.癌胚抗原(CEA)、甲胎蛋白(AFP),转铁蛋白及β_2微球蛋白(β_2MG),可用于检测恶性肿瘤,决定手术或药物治疗.Koprowski(1979)发展一种单克隆抗体称1116 NS 19-9,取自一例结直肠癌的人细胞系SW 1116,免疫BALB/C小白鼠而获得,19-9单克隆抗体与醣原决定簇(CA 19-9)即Sialylated lacto-N-facopentaose起反应.Del Villano等(1983)以放射免疫计算测定CA 19-9量,发现它对胰腺腺癌的诊断有良好的特异性和敏感性.本文报道CA 19-9对胃肠道癌特别是胰癌的诊断价值,并与上述其他标志作比较.方法:40名健康人(36～60岁),136例恶性肿瘤(17～82岁),54例良性瘤(23～85岁),每例癌肿有组织病理诊断与分期,慢性胰腺炎的诊断根据病史,及下     

肿瘤标记物在卵巢良恶性肿瘤鉴别中的意义

目的分析血清肿瘤标记物糖类抗原(CA125)、癌胚抗原(CEA)、人附睾蛋白4(HE4)在卵巢良恶性肿瘤鉴别中的意义。方法回顾性分析我院自2010年1月至2012年1月间收治的228例卵巢肿瘤患者的临床资料,探讨肿瘤标记物CA125、CEA、HE4在卵巢良恶性肿瘤鉴别中的意义。所有患者均经手术治疗并经术后病理检测确诊,其中,卵巢恶性肿瘤118例,卵巢良性肿瘤110例,所有病例资料完整,均在术前和术后进行了血清肿瘤标记物CA125、CEA、HE4的检查。结果卵巢癌组患者血清CA125、CEA、HE4水平比卵巢良性肿瘤组显著增高,差异具有统计学意义(P0.05);CA125、CEA、HE4诊断卵巢癌的敏感性分别为60.17%、29.66%、40.68%,联合检测的敏感性为88.14%,差异具有有统计学意义(P0.05)。结论血清肿瘤标记物CA125、CEA、HE4联合检测是卵巢良恶性肿瘤鉴别的有效方法,对于卵巢恶性肿瘤的早期诊断有重要意义。     

血清肿瘤标记物联合检测诊断老年肺癌价值的研究

目的　探讨联合检测血清肿瘤标记物 CEA、CA50 、CA2 4 2 、CA1 2 5、NSE在老年肺癌诊断治疗中的价值。方法　应用免疫放射分析法测定 66例老年肺癌 ,2 5例良性病变 ,2 0例经体检证明为健康老年人的五项血清肿瘤标记物水平。结果　肺癌组五项血清肿瘤标记物浓度均高于肺良性病变及健康老年组 (P<0 .0 1、P<0 .0 5) ,敏感性分别是 CEA 40 .1 % (2 4 / 66)、CA50 3 5.4% (34/ 66)、CA2 4 2 3 3.3% (2 2 / 66)、CA1 2 52 8.7% (1 9/ 66)、NSE 2 7.7% (1 8/ 66) ,联合检测敏感性达到 91 .6%。结论　联合检测 CEA、CA50 、CA2 4 2 、CA1 2 5、NSE可以显著提高老年肺癌血清肿瘤标记物的敏感性和特异性     

血清肿瘤标志物CEA、CA72-4、CA19-9的阳性预测值在消化肿瘤诊断中的价值

目的探究癌胚抗原(CEA)、糖类抗原199(CA19-9)、糖类抗原724(CA72-4)在体检人群中的胃肠道肿瘤阳性预测值及其诊断价值。方法收集因体检发现CEA、CA72-4、CA19-9任意一项或多项升高而就诊的患者219例,通过胃肠镜检查判断有无胃肠道肿瘤,计算分析CEA、CA72-4、CA19-9的阳性预测值。结果 CEA、CA19-9、CA72-4在胃肠道肿瘤中的阳性预测值分别为4.17%,3.23%和0.00%。多项肿瘤标志物联合升高的阳性预测值显著高于单项肿瘤标志物升高(P=0.002)。且肿瘤标志物的阳性预测值与年龄及临床症状有关。结论 CEA、CA72-4、CA19-9在体检人群中的胃肠道肿瘤阳性预测值不高,但对于多项肿瘤标志物联合升高,年龄40岁及合并临床症状的患者需提高警惕,进一步检查。     

卵巢上皮恶性肿瘤中糖类抗原125和癌胚抗原的临床意义

目的探讨卵巢上皮恶性肿瘤中糖类抗原125(CA125)和癌胚抗原(CEA)的临床意义。方法选择该院2011年1月至2012年12月收治的42例卵巢上皮恶性肿瘤患者为观察组,同期收治的40例卵巢良性肿瘤患者为对照组,比较两组患者血浆CA125和CEA水平,分析两组患者血浆CA125、CEA及联合诊断阳性率,观察不同病理类型卵巢上皮恶性肿瘤患者血浆CA125、CEA及联合诊断阳性率。结果观察组血浆CA125〔(539.17±723.58)U/ml〕、血浆CEA〔(9.33±6.90)ng/ml〕水平显著高于对照组〔(11.82±10.03)U/ml、(2.38±1.74)ng/ml〕(P<0.0001)。观察组血浆CA125诊断阳性率为73.81%,血浆CEA诊断阳性率为38.01%,联合诊断阳性率为92.86%;对照组为7.50%,0.75%;观察组阳性率显著高于对照组(P<0.0001)。不同病理类型卵巢上皮恶性肿瘤患者血浆CA125、CEA及联合诊断阳性率比较无统计学意义(P>0.05)。结论血浆CA125和CEA可有效反映卵巢上皮肿瘤病变程度,对于卵巢上皮恶性肿瘤的诊断、监控及预后具有重要临床意义。     

Serum concentration and immunohistochemical localization of SPan-1 antigen in pancreatic cancer. A comparison with CA19-9 antigen.

We studied SPan-1 antigen in 64 patients with pancreatic cancer by measuring serum concentrations with RIABEAD and examining the intratumor staining patterns immunohistochemically. Serum concentrations were elevated (greater than 30 U/ml) in 46 patients (72.0%), roughly the same percentage as with elevated serum CA19-9 concentrations. Ten out of 19 patients without CA19-9 antigen expressed SPan-1, and the combined rate of positivity was 86% (55/64). Immunohistochemically, CA19-9 was localized to the apical surface and the supranuclear cytoplasm of normal epithelial cells, but SPan-1 was localized to the supranuclear cytoplasm or throughout the cytoplasm. After malignant degeneration, both antigens were found over the entire plasma membrane, throughout the cytoplasm (loss of polar distribution) and in the stroma surrounding the cells. SPan-1 was detected in 48 out of 54 adeno-carcinomas of the pancreas (89%), and all cases with an elevated serum concentration displayed stromal staining in the cancer tissues. The utility of SPan-1 antigen as a tumor marker for diagnosing pancreatic cancer was found to be equal to that of CA19-9.     

Tumor M2-Pyruvate Kinase, a New Metabolic Marker for Pancreatic Cancer

An isoenzyme of pyruvate kinase (Tu M2-PK) is overexpressed by tumor cells and can be measured in blood by a specific immunoenzymatic assay. Our objective was to investigate the diagnostic value of Tu M2-PK in comparison with that of CA 19-9 in pancreatic cancer. We studied 265 subjects: 60 with histologically confirmed pancreatic cancer, 43 with benign pancreatic diseases (acute and chronic pancreatitis), 5 with benign cystic neoplasms of the pancreas, 9 with neuroendocrine tumors, 77 with other abdominal malignancies, 47 with benign digestive diseases, and 24 healthy controls. Levels of plasma Tu M2-PK and serum CA 19-9 were determined by commercially available specific immunoassays. The diagnostic sensitivity and specificity of Tu M2-PK for pancreatic cancer were 85 and 41%, respectively, while those of CA 19-9 were 75 and 81%. The combination of the two tests significantly increased sensitivity (97%) but lowered specificity (38%). In discriminating between pancreatic cancer and acute or chronic pancreatitis, Tu M2-PK turned out to be less accurate than CA 19-9. In patients without pancreatic tumor, cholestasis appeared not to affect the values of Tu M2-PK, while CA 19-9 was found to be significantly higher. Tu M2-PK was also abnormally high in the majority of patients with other digestive malignancies or neuroendocrine tumors. The results demonstrate that Tu M2-PK has a satisfactory sensitivity but a poor specificity in the diagnosis of pancreatic cancer. Used together with CA 19-9, the sensitivity increases considerably.     

Comparison of the sensitivity and specificity of the CA19-9 and carcinoembryonic antigen assays in detecting cancer of the pancreas

In this study, we determined the sensitivity and specificity of the new serum assay CA19-9 in detecting adenocarcinoma of the pancreas and compared the results with those of the serum assay to carcinoembryonic antigen (CEA). Thirty-seven patients with biopsy-proven adenocarcinoma (14 patients with resectable disease and 23 patients with unresectable disease) were compared with 157 controls (48 patients with benign pancreatic disease, 34 patients with nonpancreatic sources of abdominal pain, 58 patients with benign jaundice, 7 patients with nonpancreatic malabsorption, and 10 patients with renal failure on dialysis). It was determined that a cutoff of 75 U/ml enhanced the diagnostic efficiency (sensitivity + specificity) of CA19-9 over the manufacturer's recommended cutoff of 37 U/ml. The sensitivity of CA19-9 (greater than 75 U/ml) in detecting cancer was greater than that of CEA (greater than 5 ng/ml) (86.5% vs. 48.4%) (p less than 0.01, McNemar test). The sensitivity of CA19-9 was 78.6% in resectable and 91.3% in unresectable disease. The specificity of CA19-9 was also greater than CEA (92.5% vs. 87.3%), although this difference was not statistically significant. The higher the CA19-9 or CEA level, the greater the specificity of either assay; at CA19-9 levels greater than 600 U/ml and CEA levels greater than 20 ng/ml the specificity is approximately 99%. The combination of an elevated CA19-9 level (greater than 75 U/ml) and an elevated CEA level (greater than 5 ng/ml) also enhanced specificity to 99%. It is concluded that CA19-9 used alone is superior to CEA used alone in detecting cancer of the pancreas and that the combination of mild elevations of both assays improves their specificity. Although the CA19-9 marker can be elevated with other intraabdominal adenocarcinomas (e.g., gastric, biliary, or colonic), CA19-9, together with CEA, will be useful to the clinician in differentiating benign from malignant pancreatic processes and in alerting the clinician to the possible presence of an intraabdominal neoplasm in the proper clinical setting.     

Risk factors of pancreatic leakage after pancreaticoduodenectomy

AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage. METHODS: Sixty-two patients who underwent PD at our hospital between January 2000 and November 2003 were reviewed retrospectively. The primary diseases of the patients included pancreas cancer, ampullary cancer, bile duct cancer, islet cell cancer, duodenal cancer, chronic pancreatitis, pancreatic cystadenoma, and gastric cancer. Standard PD was performed for 25 cases, PD with extended lymphadenectomy for 27 cases, pylorus-preserving PD for 10 cases. A duct-to-mucosa pancreaticojejunostomy was performed for patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy for patients with a soft pancreas and a non-dilated duct. Patients were divided into two groups according to the incidence of postoperative pancreaticojejunal anastomotic leakage: 10 cases with leakage and 52 cases without leakage. Seven preoperative and six intraoperative risk factors with the potential to affect the incidence of pancreatic leakage were analyzed with SPSS10.0 software. Logistic regression was then used to determine the effect of multiple factors on pancreatic leakage. RESULTS: Of the 62 patients, 10 (16.13%) were identified as having pancreatic leakage after operation. Other major postoperative complications included delayed gastric emptying (eight patients), abdominal bleeding (four patients), abdominal abscess (three patients) and wound infection (two patients). The overall surgical morbidity was 43.5% (27/62). The hospital mortality in this series was 4.84% (3/62), and the mortality associated with pancreatic fistula was 10% (1/10). Sixteen cases underwent duct-to-mucosa pancreaticojejunostomy and 1 case (1/16, 6.25%) developed postoperative pancreatic leakage, 46 cases underwent invagination pancreaticojejunostomy and 9 cases (9/46, 19.6%) developed postoperative pancreatic leakage. General risk factors including patient age, gender, history of jaundice, preoperative nutrition, pathological diagnosis and the length of postoperative stay were similar in the two groups. There was no statistical difference in the incidence of pancreatic leakage between the patients who received the prophylactic use of octreotide after surgery and the patients who did not undergo somatostatin therapy. Moreover, multivariate logistic regression analysis showed that none of the above factors seemed to be associated with pancreatic fistula. Two intraoperative risk factors, pancreatic duct size and texture of the remnant pancreas, were found to be significantly associated with pancreatic leakage. The incidence of pancreatic leakage was 4.88% in patients with a pancreatic duct size greater than or equal to 3 mm and was 38.1% in those with ducts smaller than 3 mm (P = 0.002). The pancreatic leakage rate was 2.94% in patients with a hard pancreas and was 32.1% in those with a soft pancreas (P = 0.004). Operative time, blood loss and type of resection were similar in the two patient groups. The incidence of pancreatic leakage was 6.25% (1/16) in patients with duct-to-mucosa anastomosis, and was 19.6% (9/46) in those with traditional invagination anastomosis. Although the difference of pancreatic leakage between the two groups was obvious, no statistical significance was found. This may be due to the small number of patients with duct-to-mucosa anastomosis. By further analyzing with multivariate logistic regression, both pancreatic duct size and texture of the remnant pancreas were demonstrated to be independent risk factors (P = 0.007 and 0.017, OR = 11.87 and 15.45). Although anastomotic technique was not a significant factor, pancreatic leakage rate was much less in cases that underwent duct-to-mucosa pancreaticojejunostomy. CONCLUSION: Pancreatic duct size and texture of the remnant pancreas are risk factors influencing pancreatic leakage after PD. Duct-to-mucosa pancreaticojejunostomy, as a safe and useful anastomotic technique, can reduce pancreatic leakage rate after PD.     

Comparison of tumor marker CA 242 with CA 19-9 and carcinoembryonic antigen (CEA) in pancreatic cancer

BACKGROUND/AIMS: Although there are a variety of tumor markers used for diagnosis of pancreatic carcinoma, the sensitivity and specificity of those markers have not yet reached an ideal level. The aim of this study was to compare the diagnostic value of CA 242 with CA 19-9 and CEA in the patients with pancreatic cancer. METHODOLOGY: Serum CA 242, CA 19-9 and CEA levels were determined in 135 subjects in the following groups: Pancreatic cancer (n = 40), cholangiocellular carcinoma (n = 15), hepatocellular carcinoma (n = 10), cirrhosis (n = 7), chronic active hepatitis (n = 7), choledochal stone (n = 12), chronic pancreatitis (n = 9), acute pancreatitis (n = 6), and healthy controls (n = 29). RESULTS: An elevated serum CA 242 concentration (> 20 U/mL) was found in 30 out of 40 (70%) (mean; 2163 +/- 838 U/mL) patients with pancreas cancer, in 11 out of 15 patients with cholangiocellular carcinoma (93.3%) (mean 916 +/- 529 U/mL), in none of patients with hepatocellular carcinoma and healthy controls. Slightly elevated CA 242 concentration was found in 6 out of 41 patients with benign hepatobiliary and pancreatic disease (range 0.4-97.8 U/mL) (1 acute pancreatitis, 2 chronic pancreatitis, 1 cirrhosis, 2 choledochal stone). Mean serum CA 242, CA 19-9 and CEA levels of the pancreas cancer group were significantly higher than those of the other groups except the cholangiocellular carcinoma group. There was no significant difference between the stage of pancreas cancer regarding mean serum CA 242, CA 19-9 and CEA level. There was positive correlation between serum CA 242 and CA 19-9 level. In the pancreas cancer, the sensitivity of CA 242, CA 19-9 and CEA was 75%, 80%, 40%, respectively and the specificity of those markers was 85.5%, 67.5% and 73%, respectively. CONCLUSIONS: In conclusion, the advantage of CA 242 compared to CA 19-9 is that its specificity is higher than that of CA 19-9 in the diagnosis of pancreas cancer.     

Solid and cystic tumor of the pancreas--three cases report

Solid and cystic tumor of the pancreas is a rare, low-grade malignant tumor that predominantly occurs in young women. Clinically, the patients are often asymptomatic and are usually found incidentally due to other diseases. The pre-operative diagnosis is difficult due to the similarity to other cystic pancreatic lesions (such as serous adenoma, mucinous cystadenoma and endocrinologically inactive islet cell tumor), or inflammatory changes (such as pancreatic pseudocyst). This tumor has a slow growth, usually does not have metastases and has a favorable prognosis. Complete removal is the treatment of choice for the tumors arising anywhere in the pancreas. We collected specimens of pancreatic tumors that were kept at Kaohsiung Medical University Hospital (KMUH) in the past 11 years. Three cases varying in clinical course were found. The first is a case of a middle aged woman with a slow growing tumor who had a misdiagnosis of pseudocyst eight years ago. The second is a case of a young woman that showed no symptoms, while the third case was also a young woman diagnosed with a huge tumor with portal vein and inferior vessel encasement. We review some articles to revise the study of this disease in order to make the correct diagnosis before proceeding with the operation, and to provide proper treatment.     

High serum levels of DUPAN2 antigen and CA19-9 in pancreatic cancer: correlation with immunocytochemical localization of antigens in cancer cells

We determined the concentration of serum DUPAN2 and CA19-9 in 43 pancreatic cancer patients by enzyme immunoassay, and compared the staining patterns of the antigens in the tissues of pancreatic cancer in order to clarify the mechanism of the elevation of serum DUPAN2 and CA19-9 levels in the patients. In 26 patients (60%), the serum DUPAN2 concentration was higher than 300 U/ml. This positive rate was not so high as that of CA19-9. However, seven out of the twelve CA19-9-negative patients were DUPAN2-positive. Using a combined assay of serum DUPAN2 and CA19-9, the diagnostic sensitivity for pancreatic cancer was 88% (38/43). Immunocytochemically, both DUPAN2 and CA19-9 were restricted to the apical surface and/or supranuclear cytoplasm in the normal pancreatic duct epithelia. In cancerous glands, however, the two were found over the entire surface and cytoplasm of the cancer cells--losing the polar distribution pattern of the antigen--and in the surrounding stroma adjacent to the cancer cells. DUPAN2 was detected in 47 (89%) out of 53 adenocarcinomas of the pancreas, and CA19-9 in 44 cases (83%). Cases with high serum antigen levels tended to display high proportions of stromal staining in the cancer tissues. These findings suggest that shedding of the antigen into the stroma adjacent to the malignant glands is one of the major mechanisms in the elevation of high serum DUPAN2 and CA19-9 levels.     

Comparative studies of DU-PAN-2, carcinoembryonic antigen, and CA19-9 in the serum and bile of patients with pancreatic and biliary tract diseases: evaluation of the influence of obstructive jaundice

The levels of DU-PAN-2 antigen, carcinoembryonic antigen, and CA19-9 in serum and bile of patients with pancreatic and biliary tract diseases were measured. The sensitivities (true positive) of DU-PAN-2 in serum to pancreatic carcinoma (64%) and to biliary tract carcinoma (62%) were similar to those of CA19-9 in serum (69% and 72%, respectively). Nine of 18 (50%) patients with CA19-9-negative pancreatic carcinoma tested positive for DU-PAN-2. The sensitivities of CEA to pancreatic carcinoma (56%) and to biliary tract carcinoma (52%) were lowest. The measurement of these antigens in bile seemed to be of little diagnostic value in differentiating between malignant and benign diseases. False positives of these three assays occurred frequently in patients with benign pancreatic or biliary tract disease coupled with obstructive jaundice. After percutaneous transhepatic biliary drainage, serum DU-PAN-2 and CA19-9 levels returned to normal ranges in patients with benign diseases, but not in patients with carcinoma of the pancreas or of the biliary tract. Serum CA19-9 and DU-PAN-2 antigens are useful tumor markers for pancreatic and biliary tract carcinomas. Longitudinal assays of these antigens may be useful for the differential diagnosis of patients with obstructive jaundice.     

Prognostic impact of preoperative NLR and CA19-9 in pancreatic cancer

BackgroundRecently, several preoperative proinflammatory markers and nutritional factors such as neutrophil-to-lymphocyte ratio (NLR) and prognostic nutrition index (PNI) have been reported as significant predictor for poor prognosis of various malignant tumors. In this study, we evaluated the prognostic values of these preoperative parameters in patients with resectable pancreatic head cancer.MethodsWe retrospectively reviewed consecutive patients who underwent PD for pancreatic head cancer between 2007 and 2012. A total of 46 patients were enrolled in this analysis. Preoperative parameters such as CRP, CA19-9, NLR and PNI at the time of presentation were recorded as well as overall survival. Cancer specific survival was assessed using Kaplan–Meier method. Univariate and multivariate Cox regression models were applied to evaluate the prognostic relevance of preoperative parameters. The correlations between CA19-9 values, NLR and pathological findings, first recurrence site were respectively reviewed.ResultsIn multivariable analysis preoperative high NLR (≧2.7) and high CA19-9 (≧230) were independent prognostic factors for poor survival (P value: 0.03 and 0.025, respectively). Kaplan–Meier survival analysis demonstrated the overall 2-year survival rate in patients with high NLR or high CA19-9 were 37.5% compared with 89.9% in patients with low NLR and low CA19-9.ConclusionPreoperative NLR and serum CA19-9 offer significant prognostic information associated with overall survival following PD in the patients with pancreatic head cancer.     

Endoscopic ultrasound in pancreatic tumor diagnosis

In a prospective study from 1988 to 1990, 132 patients with suspected pancreatic tumor were examined with endoscopic ultrasound (EUS), transabdominal ultrasound (US), computed tomography (CT), and ERCP. The final diagnosis of 102 pancreatic tumors of different origin (76 malignant and 26 inflammatory tumors) and the exclusion of a pancreatic tumor in 30 patients was made by operation (N = 47), puncture (N = 36), autopsy (N = 3), or follow-up of a mean of 51 weeks (N = 46). Sensitivity and specificity in pancreatic tumor diagnosis were significantly higher for EUS (99% and 100%) than for US (67%/40%) and CT (77%/53%) and equal to ERCP (sensitivity 90%). This was even more obvious in small pancreatic tumors of 3 cm and less. However, as with the other imaging procedures, EUS was not able to differentiate reliably malignant from inflammatory pancreatic masses (accuracy 76% for malignancy and 46% for focal inflammation). From analysis of the endosonographic pattern of pancreatic tumors, no consistent morphologic features were identified which could have been specifically attributed to malignant or inflammatory masses. Our results show that EUS is superior to US and CT and equal to ERCP in pancreatic tumor diagnosis. In contrast to the indirect evidence obtained by ERCP, EUS provides direct visualization of tumor size and shape in almost all patients examined. Thus, EUS should be considered early in the evaluation of patients with suspected pancreatic tumors.