血清CA19-9水平术前评估胰腺癌可切除性的临床价值

目的 评价血清CA19-9水平在胰腺癌术前可切除性评估中的临床价值.方法 测定52例术前影像学提示有手术切除可能性并经手术活检或术后病理确诊的胰腺癌患者术前血清CA19-9水平,以手术能否切除为金标准,绘制CA19-9的受试者工作特征(ROC)曲线,并以敏感度和特异度之和最大点即曲线左上方作为相应截断点测CA19-9的敏感度、特异度及阳性、阴性预测值.结果 52例胰腺癌患者中手术切除29例(55.8%),未切除23例(44.2%).手术切除组患者血清CA19-9水平为(159.6±170.9)U/ml,未切除组患者为(944.4±773.4)U/ml;CA19-9的ROC曲线下面积0.918(＞0.9),P＜0.01,95%可信区间0.843～0.992,左上方截断点CA19-9值为353.2 U/ml.以此为标准,敏感度93.1%,特异度78.3%,阳、阴性预测值分别为84.4%和90.0%.结论术前血清CA 19-9水平可作为影像学提示有手术切除可能的胰腺癌患者进一步评估的辅助指标.

Clinical value of serum CA19-9 levels in preoperative evaluation of resectability of pancreatic carcinoma

Objective To evaluate the value of serum CA 19-9 levels in predicting resectability of pancreatic cancer. Methods Serum CA 19-9 levels of 52 patients with pancreatic cancer who were possible to be curatively resected according to the imaging were determined; the gold standard was respectability. An receiver operating characteristic (ROC) curve was constructed for the CA 19-9 levels; the point that lies closest to the upper left-hand comer of the graph is chosen as the cut-off point, the sensitivity, specificity,positive and negative predictive values were calculated. Results There were 29 (55.8%) resectable and 23 (44.2%) inoperable cases of pancreatic cancers. The CA19-9 level in resectable patients was (159.6±170.9)U/ml, and it was (944.4 ±773.4) U/ml in inoperable cases. The area under the ROC curve was 0. 918 ( ＞ 0.9, P ＜ 0.01 ), 95% confidence interval were 0.843 ～ 0.992. The CA19-9 level was (353.2) U/ml according to the cut-off point, the sensitivity and specificity was 93.1% and 78.3%, respectively; positive and negative predictive values was 84. 4% and 90. 0% , respectively. Conclusions Preoperative serum CA19-9 level may be a useful marker for further evaluating the respectability of pancreatic cancer who are possible to be resected according to the imaging studies.