肿瘤标志物CA19-9、CEA在肝门胆管癌可切除性预测中的价值

The Value of CA19-9 and CEA in Predicting Resectability of Hilar Cholangiocarcinoma

目的探讨肿瘤标志物糖类抗原19-9(CA19-9)、癌胚抗原(CEA)在肝门胆管癌根治手术可切除性判断应用和术前预测价值。方法回顾性分析肝门胆管癌手术患者103例,通过ROC曲线分析等对肿瘤标志物在肿瘤可切除性判断中的价值进行评估。结果 ROC分析得出CA19-9和CEA的新界值分别为400μg/L和8μg/L,各自的ROC曲线下面积分别为0.605±0.057和0.631±0.055,按新界值并联联合检测CA19-9和CEA(其中一项阳性即判定不可切除,两项阴性判定可切除)来预测肝门胆管癌根治手术可切除性,其ROC曲线下面积、敏感性、特异性、阴性预测值、阳性预测值分别为0.660±0.054、62.79%、65.00%、56.25%、83.33%。结论"CA19-9<400μg/L+CEA<8μg/L"提示肝门胆管癌根治切除可能性大,"CA19-9≥400μg/L或CEA≥8μg/L"提示其根治切除可能性小。在对患者临床表现、影像学检查等资料进行综合分析的前提下,结合CA19-9和CEA作为肝门胆管癌术前判断可切除性的新辅助指标,可以进一步减少外科治疗的盲目性。

Objective To evaluate the predictability of preoperative serum Carbonhydrate antigen（CA19-9）and Carcino-embryonic antigen（CEA）for tumor resectability in the patients with hilar cholangiocarcinoma（HC）.Methods One hundred and three HC patients pathologically diagnosed from 2003 to 2012were divided into radical resection group and palliative treatment group according to their surgical therapy and resection results,and preoperative serum CA19-9 and CEA data was collected and analyzed retrospectively.Receiver operating characteristic（ROC）curve analysis was applied to find the best cut-off point,and the resectability prediction of different detection methods was evaluated.Results In the application of ROC analysis,the cut-off point of CA19-9and CEA were 400μg/L and 8μg/L with the largest Youden＇s index 0.2345（AUC=0.605±0.057）and 0.1635（AUC=0.631±0.055）respectively.The ROC-AUC,sensitivity,specificity,negative predictive value and positive predictive value in the combine detection（parallel test）with this new cut-off point were 0.660±0.054,62.79%,65.00%,56.25% and 83.33% respectively.Conclusion The HC patients with ＂CA19-9400μg/L ＋ CEA8μg/L＂may have big opportunity to have radical resection while those with＂CA19-9≥400μg/L or CEA≥8μg/L＂may have small opportunity.