血清CA19-9预测吉西他滨化疗的晚期胰腺癌患者的预后

Clinical value of serum CA19-9 decline on predicting prognosis in patients with advanced pancreatic cancer receiving gemcitabine chemotherapy

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。

Objective： To investigate the relationship among pre-and post-chemotherapy CA19-9 level,radiological objective response and clinical benefit response.Methods： We compared CA19-9 decline rate,objective response and clinical benefit response as surrogate end points for prognosis in patients with advanced pancreatic cancer receiving gemcitabine based chemotherapy.Results： The median survival time（MST） of all 64 patients was 7.0 months.MST of patients with baseline serum CA19-9 level less than 928.6ng/ml were significantly longer than those with greater（9.4 months vs 4.2 months,P0.001）.MST of patients with CA19-9 decrease ratio ≥25% after 2 cycles of chemotherapy were significantly longer than those less（8.9 months vs 4.4 months,P0.001）.MST of patients with non-progression disease（NPD） were significantly longer than progression（PD）（8.8 months vs 7.4 months,P=0.022）;MST of patients with clinical benefit response（CBR） was longer than non-CBR（9.1 months vs 6.2 months,P=0.022）.Multivariate analysis showed that serum CA19-9 levels less than the median value and serum CA19-9 decreased ratio ≥25% were independent prognostic factors of survival,but NPD and CBR were not prognostic factors.Conclusion： Compared to radiological objective response and clinical benefit response,serum CA19-9 level is more effectively on predicting prognosis survival.Serum CA19-9 level is a more reasonable marker for guiding clinical treatment of patients with advanced pancreatic cancer.