CA199变化趋势与胰腺癌预后的关系

Relationship between CA199 and prognosis of patients with advanced pancreatic cancer

目的研究化疗2周期后CA199下降水平与晚期胰腺癌预后的关系。方法本研究纳入了解放军总医院第一医学中心2010-2018年110例晚期胰腺癌患者,男性74例,女性36例,年龄范围在30～79岁;检测基线CA199值及2周期化疗后CA199值,按照不同下降水平(化疗2周期后的CA199值较基线水平下降vs未下降、下降≥20%vs下降<20%、下降≥40%vs下降<40%)以及不同的化疗方案进行分组,并进行亚组生存分析。结果化疗2周期后,较基线CA199水平下降者比CA199未下降者mOS更长(10.4个月vs5.8个月,P=0.009),mPFS也更长(4.7个月vs3.1个月,P=0.002)。CA199下降≥20%者较下降<20%者mOS(11.0个月vs 5.9个月,P=0.004)、mPFS更长(5.0个月vs 3.1个月,P=0.001)。CA199下降≥40%者较下降<40%者的mOS(11.1个月vs 6.6个月,P=0.014)、mPFS(4.8个月vs3.5个月,P=0.042)更长。在不同化疗方案中,吉西他滨联合白蛋白紫杉醇及吉西他滨联合替吉奥疗效较其他方案效果更好。同时,在每种化疗方案中,CA199下降比例越大,预后越好。结论化疗2周期后CA199的下降水平可以作为化疗疗效的评估指标。

Objective To analyze the relationship between level of CA199 decrease after two cycles of chemotherapy and prognosis in patients with advanced pancreatic cancer. Methods Totally 110 patients with advanced pancreatic cancer treated in our hospital from 2010 to 2018 were enrolled into our study. There were 74 males and 36 females with age ranging from 30 to 79 years old.CA199 was measured at baseline and after two cycles of chemotherapy. According to the decrease of CA199 level(CA199 changed from baseline to 2 cycles after chemotherapy: decrease>0 vs decrease≤0;decrease≥20% vs decrease<20%;decrease≥40% vs decrease<40%) and different chemotherapy protocol, patients were divided into different groups. And then survival analysis was performed. Results After 2 cycles of chemotherapy, the mOS and mPFS of patients with CA199 decrease>0 was 10.4 months and4.7 months, which was significantly longer than those of patients with decrease≤0(mOS, 5.8 months;mPFS, 3.1 months)(P <0.05, respectively), and they were also found to be longer in patients with CA199 decrease≥20% than patients with decrease<20%(mOS: 11.0 months vs 5.9 months, P=0.004;mPFS: 5.0 months vs 3.1 months, P=0.001). Compared to the patients with CA199 decrease<40%, patients with CA199 decrease ≥40% had better prognosis(mOS, 11.1 months vs 6.6 months, P=0.014;mPFS,4.8 months vs 3.5 months, P=0.042). Gemcitabine plus S1 and Gemcitabine plus nab-Paclitaxel had better efficacy than other chemotherapy regimens. And the more CA199 decrease, the better prognosis patients had. Conclusion CA199 decrease after 2 cycles of chemotherapy can be an early indicator for chemotherapy efficacy.