糖链抗原19-9与胰腺癌体积比值对胰腺癌术后远期生存的意义

目的评估糖链抗原19-9(CA19-9)与胰腺癌体积(TTV)比值(CA19-9/TTV)作为预后标志物,对行胰十二指肠切除术的胰腺导管腺癌患者远期生存的预测价值和意义。方法回顾性分析2011年1月至2019年12月在首都医科大学附属北京朝阳医院因胰腺导管腺癌行胰十二指肠切除术的203例患者资料。通过单因素及多因素分析,筛选出影响胰腺癌术后远期预后的危险因素。根据术前血清CA19-9水平及TTV计算CA19-9/TTV,并依据CA19-9/TTV与患者1年生存情况绘制ROC曲线,由此确定CA19-9/TTV的最佳cut-off值,并将患者分组。比较两组患者的临床一般资料及术后并发症差异,探究其与胰腺癌患者行胰十二指肠切除术远期预后的关系。结果患者总体中位生存时间为18个月,术后1、3、5年总体生存率分别为64.1%、25.6%、15.2%。肿瘤分化程度、CA19-9/TTV是影响胰腺导管腺癌远期预后的独立危险因素(P=0.002、0.005)。ROC曲线最佳cut-off值为5.62(曲线下面积:0.633,95%CI:0.548~0.718),CA19-9/TTV≤5.62组和CA19-9/TTV>5.62组患者的一般临床资料差异无统计学意义,总体中位生存时间分别为26个月和15个月,术后1、3、5年总体生存率分别为82.7%、40.8%、24.8%和57.5%、19.0%、11.2%(P=0.002)。结论高水平的CA19-9/TTV提示胰腺癌患者行胰十二指肠切除术预后不良。CA19-9/TTV可以作为预测胰腺癌术后远期预后的标志物。

Carbohydrate antigen 19-9 level to total tumor volume as a predictor of pancreatic carcinoma recurrence and long-term prognosis after curative resection

Objective To evaluate the effect of carbohydrate antigen 19-9(CA19-9)/total tumor volume(TTV),the ratio of CA19-9 to TTV,as a prognostic marker on tumor recurrence and long-term survival in patients with pancreatic ductal adenocarcinoma(PDAC)following pancreaticoduodenectomy(PD).Methods The data of 203 patients who underwent PD for PDAC in Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2011 to December 2019 were analyzed.Univariate and multivariate analyses were performed of the clinicopathological data to screen out the risk factors affecting long-term prognosis of PDAC.CA19-9/TTV was calculated according to preoperative CA19-9 and TTV,and the ROC curve was drawn based on CA19-9/TTV and 1-year survival,so as to determine the optimal cut-off value of CA19-9/TTV and group criterion.The differences of clinicopathological data and postoperative complications between the two groups were compared to explore their relationship with long-term prognosis in patients with PDAC undergoing PD.Results The median overall survival(OS)was 18 months,and the 1-,3-,and 5-year OS rates were 64.1%,25.6%and 15.2%,respectively.Tumor differentiation and CA19-9/TTV were independent risk factors for long-term prognosis of PDAC(P=0.002,0.005).The best cut-off value of ROC curve was 5.62(area under curve,0.633;95%CI:0.548-0.718).Patients with CA19-9/TTV≤5.62 were labeled as Group 1,and others were Group 2.There was no significant difference in clinicopathological data between the two groups.The median OS in Group 1 and Group 2 was 26 and 15 months respectively,and the 1-,3-and 5-year OS rates were 82.7%,40.8%,24.8%and 57.5%,19.0%,11.2%,respectively(P=0.002).Conclusion CA19-9/TTV is an independent risk factor for the prognosis of PDAC after PD,which may be a new marker for lower survival benefits.