术前血清CA125预测血清CA19-9正常胰腺癌患者术后生存的价值

Predictive value of preoperative serum CA125 for survival of pancreatic cancer patients with normal level of preoperative serum CA19-9

目的:分析糖类抗原125(CA125)在CA19-9正常胰腺癌人群中的预后预测价值。方法:回顾性分析2010年3月至2015年12月在复旦大学附属肿瘤医院胰腺肿瘤研究所接受根治性切除的182例术前CA19-9正常胰腺癌患者的临床资料。分析血清CA125与患者临床病理特征的关系。采用Kaplan-Meier生存曲线和多因素Cox回归分析模型分析血清CA125对患者预后的预测价值。结果:术前血清CA125高水平患者的肿瘤分化程度越差(P=0.013),淋巴结转移发生率更高(P=0.016)。术前血清CA125高水平患者的中位总生存时间(OS,16.8个月)和无复发生存时间(RFS,10.4个月)显著短于术前血清CA125低水平患者(OS:>24.3个月,P<0.001;RFS:16.3个月,P=0.001)。多因素Cox回归分析显示,术前血清CA125高水平是术前血清CA19-9正常胰腺癌患者OS(风险比=2.171,95%置信区间1.229~3.836,P=0.008)和RFS(风险比:1.648,95%置信区间1.114~2.438,P=0.012)短的独立预测因子。结论:术前血清CA125是术前血清CA19-9正常胰腺癌患者的独立预后预测因子,能为患者术后辅助治疗策略的选择提供依据。

Objective:To analyze the prognostic value of carbohydrate antigen 125(CA125)for pancreatic cancer patients with normal CA19-9.Methods:The clinical data of 182 pancreatic cancer patients with normal preoperative CA19-9 underwent radical resection at the Pancreatic Cancer Institute of Fudan University,Shanghai Cancer Center from March 2010 to December 2015 were retrospectively analyzed.The relationship between serum CA125 and clinicopathological characteristics was analyzed.Kaplan-Meier survival curve and multivariate Cox regression analysis were used to analyze the prognostic value of serum CA125 in patients.Results:Patients with higher preoperative serum CA125 level had worse tumor differentiation(P=0.013)and lymph node metastasis(P=0.016).The median over survival(OS,16.8 months)and recurrence-free survival(RFS,10.4 months)of patients with higher level of serum CA125 before surgery were significantly shorter than those of patients with lower level of preoperative serum CA125(OS:>24.3 months,P<0.001;RFS:16.3 months,P=0.001).Multivariate Cox regression analysis results showed that high level of preoperative serum CA125 level was an independent predictor of short OS(hazard ratio=2.171,95%confidence interval 1.229-3.836,P=0.008)and RFS(hazard ratio=1.648,95%confidence interval 1.114-2.438,P=0.012)in pancreatic cancer patients with normal preoperative serum CA19-9 level.Conclusions:Preoperative serum CA125 level is an independent prognostic factor for pancreatic cancer patients with normal preoperative serum CA19-9 level,which would provide evidence for the selection of postoperative adjuvant treatment strategies.