血清CA19-9联合CEA判断胰腺癌可切除性的临床价值

Serum Carcinoembryonic Antigen Combined with Carbohydrate Antigen 19-9 for the Evaluation of Resectability in Patients with Pancreatic Cancer

目的:探讨血清CA19-9联合CEA判断胰腺癌可切除性的临床价值。方法:将2014年5月至2016年5月我院收治的62例胰腺癌患者,根据其术中是否可切除分为可切除组和不可切除组,检测两组患者血清CA19-9和CEA水平。通过受试者工作特征(ROC)曲线确定最佳分界点,采用诊断性试验比较联合指标与单一指标在判断胰腺癌可切除性的诊断效能上的差异。结果:62例患者中38例(61.29%)纳入可切除组,24例(38.71%)纳入不可切除组;切除组外周血清CA19-9和CEA的浓度为(193.53±106.37)U/m L、(5.63±3.15)μg/m L,显著低于不可切除组[(623.53±326.43)U/m L、(21.34±11.34)μg/m L],差异有统计学意义(P<0.05);ROC曲线分析,CEA和CA19-9对胰腺癌可切除性判断的最佳分界点为8.53μg/m L和316.42 U/m L,其敏感性为86.11%和89.19%,特异性为73.08%和80.00%,阳性预测值为86.11%和89.19%,阴性预测值为73.07%和80.00%,误诊率为26.92%和20.00%,漏诊率为13.89%和10.81%,正确率为80.65%和85.48%,ROC曲线下面积为0.817和0.826;CEA联合CA19-9判断胰腺癌可切除性的敏感性为86.11%,特异性为91.67%,阳性预测值为75.86%,阴性预测值为93.94%,误诊率为8.33%,漏诊率为13.89%,正确率为85.48%。结论:CA19-9联合CEA在判断胰腺癌的可切除性的诊断效能上较单一指标更高,尤其是在提高特异性和阴性预测值方面更具优势,具有较好的临床应用价值。

Objective To explore the preoperative serum carcinoembryonic antigen（ CEA） combined with carbohydrate antigen 19-9（ CA19-9） levels for the evaluation of curability and resectability in patients with pancreatic cancer. Methods Sixty-two patients with pancreatic cancer in our hospital from May 2014 to May 2016 were included. According to the surgical resection,the patients were divided into two groups： the resection group and the non resection group. The levels of serum CA19-9 and CEA were detected in the two groups. The receiver operating characteristic（ ROC） curve was used to determine the cut-off point and compared with the diagnostic efficacy of the combination and single criterion in determining the resectability of pancreatic cancer. Results Thirty-eight cases were included in the resection group and 24 cases were included in the non resection group. The serum levesl of CA19-9 and CEA in resection group were（ 193.53±106.37） U/m L and（ 5.63±3.15） μg/m L respectively,which were significantly lower than those in non resection group[（ 623.53±326.43）U/m L and（ 21.34±11.34） μg/m L]（ P0.05）. Based on the analysis of ROC curve,the cut-off points of CEA and CA19-9 to determine the resectability of pancreatic carcinoma were 8.53 ug/m L and 316.42 U/m L respectively. The corresponding sensitivity,specificity,positive predictive value,negative predictive value,misdiagnosis rate,missed diagnosis rate and correct rate were 86.11% and 89.19%,73.08% and 80.0%,86.11% and 89.19%,73.07% and 80.00%,26.92% and20.0%,13.89% and 10.81%,80.65% and 85.48% When both CEA and CA19-9 were used to determine the resectability of pancreatic carcinoma,the corresponding sensitivity,specificity,positive predictive value,negative predictive value,misdiagnosis rate,missed diagnosis rate and correct rate were 86. 11%,91. 67%,75. 86%,93. 94%,8. 33%,13. 89%,85. 48%. Conclusion The diagnostic efficiency of CA19-9 combined with CEA was higher than that of single index in evaluating the resectability of pancreatic cancer,especially for the improvement of specificity and negative predictive value.