血清肿瘤标志CA19-9在胰腺癌诊断、治疗和预后中的应用(英文)

SERUM TUMOR MARKER CARBOHYDRATE ANTIGEN 19-9 FOR THE DIAGNOSIS AND PROGNOSIS OF PANCEREATIC CANCER

目的 评价血清肿瘤标志CA19- 9在胰腺癌诊断、治疗和预后中的作用。方法 应用放射免疫法检测 4 0胰腺癌、92例其它消化道癌和 115例良性胆胰疾病病人的血清CA19- 9,结合B超、CT、MRCP和 /或ERCP等检查及临床病理、手术和预后资料 ,探讨血清CA19- 9检测对胰腺癌的临床意义。结果 胰腺癌病人的血清CA19- 9值 (196 .7± 98.8U·ml-1)和阳性率 (90 .0 % )均高于肝癌 (70 .6± 6 0 .0U·ml-1,5 8.3% ,P <0 .0 1)、胃十二指肠癌 (34.9± 5 5 .2U·ml-1,2 5 .0 % ,P <0 .0 1)、结直肠癌 (2 9.8± 4 4 .8U·ml-1,2 1.9% ,P<0 .0 1)和胰腺炎 (10 .2± 13.7U·ml-1,6 .3,P <0 .0 1)、胆管结石性黄疸 (4 6 .7± 4 3.0U·ml-1,4 0 .7% ,P <0 .0 1)及胆囊炎胆石症 (13.5± 15 .4U·ml-1,10 .0 % ,P <0 .0 1)等。将 10 0U·ml-1作为CA19- 9临界值 ,其诊断胰腺癌的特异性和准确性可分别从 6 8.5 %和 74 .6 %提高到 83.4 %和 81.6 % ;若结合B超、CT或MRCP/ERCP检查 ,诊断符合率可达 10 0 % ,并有助于鉴别肝外胆管癌。血清CA19- 9与胰腺癌的临床分期、肿瘤大小和部位无关。胰腺癌切除后病人血清CA19- 9可迅速降至正常 ;一旦局部复发或远处转移又复增高。结论 血清CA19- 9检测对胰腺癌的诊断。

Objective To evaluate serum tumor marker carbohydrate antigen 19-9 (CA 19-9) for the diagnosis and prognosis of pancreatic cancer.Patients and Methods Serum CA 19-9 levels were determined serially by immunoradiometric assay in 40 patients with pancreatic cancer,92 with other gastrointestinal cancers and 115 with benign pancreatiobiliary diseases.In the patients with pancreatic cancer,preoperative examinations include routine ultrasonography,CT-scan of the adbomen,MRCP and/or ERCP;clinical courses with respect to the pathological data,surgical procedures employed and the prognosis of these patients were followed up and compared.Results Serum CA 19-9 level (196.7±98.8 U/ml) and the positive rate (90.0%) in patients with pancreatic cancer were significantly higher than those with the cancers of the liver (70.6±60.0 U/ml,58.3%,P<0.01),gastroduodenum (34.9±55.3 U/ml,6.3%,P<0.01),colorectum (29.8±44.8 U/ml,21.9%,P<0.01),and those with pancreatitis (10.2±13.7 U/ml,6.3%,P<0.01),jaundice due to choledocholithiasis (46.7±43.0 U/ml,40.7%,P<0.01),cholecystitis with gallstones (13.5±15.4 U/ml,10.0%,P<0.01),etc.,respectively.When 100 U/ml was taken as the cut-off value,the specificity and the accuracy of serum CA 19-9 for the diagnosis of pancreatic cancer reached form 68.5% and 74.6% to 83.4% and 81.6%,respectively.If combined examinations of CA 19-9 with ultrasonography,CT and MRCP/ERCP were conduced;the diagnostic accuracy might recah 100% and might be helpful for differentiating from extrahepatic bile duct cancer.There were no significant relations between the serum CA 19-9 level and clinicopathological features of pancreatic cancer such as staging,size and location.Serum CA 19-9 level decreased rapidly to the normal range after tumor resection,whereas a secondary elevation of the levels was observed before the locoregional recurrence and distant metastases of the disease after operation.Conclusion Serum CA 19-9 may be of useful tumor marker for diagnosis of pancreatic carcinoma,prediction of the prognosis of the patients after resection and monitoring the metastases and recurrence of the disease.