用于胰头癌可切除性判断的术前血清标志物筛选

Screening of serum markers for estimation of resectability of pancreatic head cancer

目的:探讨术前血清肿瘤标记物糖类抗原(CA19-9、CA50、CA242、CA125)和癌胚抗原(CEA)水平对胰头癌可切除性评估的临床价值。方法:回顾性分析2014年1月—2015年12月收治的104例胰头癌患者的临床资料,筛选与胰头癌可切除性相关的血清肿瘤标记物,并采用受试者工作特性曲线(ROC)与曲线下面积(AUC)分析其对胰头癌可切除性的预测价值。结果:104例患者均行手术探查,其中可切除54例(可切除组),不可切除50例(不可切除组)。两组术前血清CA50和CEA水平差异无统计学意义(均P>0.05),而不可切除组CA19-9、CA242和CA125水平明显高于可切除组(317.99k U/Lvs.152.98k U/L;67.81k U/Lvs.39.36k U/L;71.53k U/Lvs.29.22k U/L,均P<0.05)。ROC分析得出CA19-9和CA125对胰头癌可切除性均具有判断价值,其最佳截断点分别为236.13k U/L和16.44k U/L,AUC值分别为0.667和0.678(均P<0.05),而单项检测CA242对胰头癌可切除性诊断无明显判别价值(AUC=0.609,P=0.085)。CA19-9、CA125联合诊断对胰头癌可切除性诊断的灵敏度和特异性提高。结论:术前检测血清CA19-9和CA125水平可作为辅助指标应用于胰头癌的可切除性评估,两者联合检测更能提高灵敏度和特异性。

Objective： To investigate the clinical value of preoperative serum levels of carbohydrate antigens （CA19-9, CA50, CA242, CA125） and carcino-embryonic antigen （CEA） in predicting resectability of pancreatic head cancer. Methods： The clinical data of 104 patients with cancer in the head of the pancreas admitted between January 2014 and December 2015 were analyzed retrospectively. The serum tumor markers associated with the resectability of pancreatic head cancer were picked up, and their predictive values for the resectability of pancreatic head cancer were determined by receiver operating characteristic curve （ROC） and the area under ROC curve （AUC）. Results： All the 104 patients received surgical exploration, by which, the tumors in 54 cases were considered resectable （resectable group）, and in 50 cases were unresectable （unresectable group）. The preoperative serum CAS0 and CEA levels showed significant difference between the two groups （both P〉0.05）, while the preoperative serum CA19-9, CA242 and CA125 levels in unresectable group were significantly higher than those in resectable group （317.99 kU/L vs. 152.98 kU/L; 67.81 kU/L vs. 39.36 kU/L; 71.53 kU/L vs. 29.22 kU/L, all P〈0.05）. ROC analysis showed that both CA19-9 and CA125 had predictive significance for the resectability of pancreatic head cancer, with the optimal cut-offvalue of 236.13 kU/L and 16.44 kU/L, and AUC of 0.667 and 0.678 respectively, while lone detection of CA242 had no predictive significance for the resectability of pancreatic head cancer （AUC=0.609, P=0.085）. The sensitivity and specificity for predicting resectability of pancreatic head cancer were increased by combined detection of CA19-9 and CA125. Conclusion： Preoperative serum CA19-9 and CA125 levels can be used as auxiliary indicators for estimating the resectability of pancreatic head cancer, and their combined detection may increase the diagnostic sensitivity and specificity.