BACKGROUND:CA19-9 is a carbohydrate tumor-associated antigen which is frequently upregulated in pancreatobiliary neoplasia.However,it may also be elevated in patients with jaundice in the absence of a tumor due to bil...BACKGROUND:CA19-9 is a carbohydrate tumor-associated antigen which is frequently upregulated in pancreatobiliary neoplasia.However,it may also be elevated in patients with jaundice in the absence of a tumor due to biliary obstruction,and in other non-hepato-pancreatico-biliary conditions.This study aimed to evaluate whether CA19-9 levels could accurately differentiate between benign and malignant pancreatobiliary disease.METHODS:All patients referred to a single surgeon for investigation of pancreaticobiliary disease in 2003 in whom a firm diagnosis had been established were included.For malignant disease,a histological diagnosis was required but for benign disease a firm radiological diagnosis was deemed adequate.The patients were divided into 4 categories:pancreatic adenocarcinoma(PCa);cholangiocarcinoma(CCa);chronic pancreatitis(CP)and biliary calculous disease(Calc).Bilirubin and alkaline phosphatase levels corresponding to the point of assessment of CA19-9 were also noted.RESULTS:Final diagnoses were made of pancreatic adenocarcinoma(PCa,n=73),cholangiocarcinoma(CCa,n=19),ampullary carcinoma(Amp,n=7),neuroendocrine carcinoma(Neu,n=4),duodenal carcinoma(Duo,n=3),chronic pancreatitis(CP,n=115),and biliary calculous disease(Calc,n=27).Median CA19-9 levels(U/ml)were:PCa,653;CCa,408;Duo,403;Calc,27;CP,19;Neu,10.5;Amp,8(reference range:0-37).The CA19-9 levels were significantly greater for malignant than for benign disease,could differentiate PCa from CCa/Duo,and were significantly higher in unresectable than in resectable PCa.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)for CA19-9 were 84.9%,69.7%,67.7%and 86.1%,respectively.A ROC analysis provided an area under the curve for CA19-9 of 0.871(0.820-0.922),giving an optimal CA19-9 of 70.5 U/ml for differentiating benign from malignant pathology.Using this cut-off,the sensitivity was 82.1%,while specificity,PPV and NPV improved to 85.9%,81.3%and 86.5%,respectively.When standard radiology was included(US/ CT/MRCP)in the decision process,the results improved to 97.2%,88.7%,86.6%,and 97.7%.For benign disease,the CA19-9 correlated directly with the serum bilirubin,but for malignant disease,CA19-9 levels were elevated independent of the bilirubin level.CONCLUSIONS:CA19-9 is useful in the differentiation of pancreatobiliary disease and when using an optimized cut-off and combining with routine radiology,the diagnostic yield is improved significantly,thus stressing the importance of a multi-disciplinary approach to pancreatobiliary disease.展开更多
BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a common cancer with increasing morbidity and mortality due to changes of social environment.AIM To evaluate the significance of serum carbohydrate antigen 19-9(CA19...BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a common cancer with increasing morbidity and mortality due to changes of social environment.AIM To evaluate the significance of serum carbohydrate antigen 19-9(CA19-9)and tumor size changes pre-and post-neoadjuvant therapy(NAT).METHODS This retrospective study was conducted at the Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment,Chongqing University Cancer Hospital.This study specifically assessed CA19-9 levels and tumor size before and after NAT.RESULTS A total of 156 patients who completed NAT and subsequently underwent tumor resection were included in this study.The average age was 65.4±10.6 years and 72(46.2%)patients were female.Before survival analysis,we defined the post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level as the CA19-9 ratio(CR).The patients were divided into three groups:CR<0.5,CR>0.5 and<1 and CR>1.With regard to tumor size measured by both computed tomography and magnetic resonance imaging,we defined the post-NAT tumor size/pre-NAT tumor size as the tumor size ratio(TR).The patients were then divided into three groups:TR<0.5,TR>0.5 and<1 and TR>1.Based on these groups divided according to CR and TR,we performed both overall survival(OS)and disease-free survival(DFS)analyses.Log-rank tests showed that both OS and DFS were significantly different among the groups according to CR and TR(P<0.05).CR and TR after NAT were associated with increased odds of achieving a complete or near-complete pathologic response.Moreover,CR(hazard ratio:1.721,95%CI:1.373-3.762;P=0.006),and TR(hazard ratio:1.435,95%CI:1.275-4.363;P=0.014)were identified as independent factors associated with OS.CONCLUSION This study demonstrated that post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with OS in patients with PDAC who received NAT and subsequent surgical resection.展开更多
目的探讨糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)在胆囊癌根治手术后患者疾病转归中的临床意义。方法选取2015年1月至2021年12月于临沂市中心医院行胆囊癌根治...目的探讨糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)在胆囊癌根治手术后患者疾病转归中的临床意义。方法选取2015年1月至2021年12月于临沂市中心医院行胆囊癌根治术且均完成1年随访的72例胆囊癌患者为胆囊癌组,其中,男39例,女33例,年龄(63.19±3.85)岁。根据1∶1配对原则,另选取同期72例胆囊息肉患者为对照组,其中,男37例,女35例,年龄(62.54±3.52)岁。比较两组入院时血清CA19-9水平、NLR,比较入院时、术后1周不同疾病转归胆囊癌患者血清CA19-9水平、NLR,比较不同病理学参数胆囊癌患者血清CA19-9水平、NLR。Spearman分析入院时血清CA19-9水平、NLR与病理学参数及疾病转归的相关性。采用受试者操作特征曲线(receiver operating characteristic curve,ROC)分析入院时、术后1周血清CA19-9水平、NLR联合检测对胆囊癌患者转归不良的预测价值。结果入院时,胆囊癌组血清CA19-9水平、NLR均高于对照组[(237.14±38.41)U/ml比(31.87±6.43)U/ml、(4.02±1.25)比(1.84±0.43);均P<0.05]。转归不良患者入院时、术后1周血清CA19-9水平、NLR均高于转归良好患者[(261.71±25.33)U/ml比(218.56±24.52)U/ml、(4.73±1.02)比(3.48±0.75),(181.64±28.58)U/ml比(85.43±12.19)U/ml、(3.37±0.48)比(2.24±0.53);均P<0.05]。不同病理参数胆囊癌患者血清CA19-9水平、NLR比较:中高分化患者低于低分化患者[(208.41±22.83)U/ml比(294.60±23.18)U/ml、(3.14±0.47)比(5.78±0.69)],Ⅰ~Ⅱ期患者低于Ⅲ~Ⅳ期患者[(188.43±25.63)U/ml比(276.11±23.08)U/ml、(2.95±0.57)比(4.88±0.64)],无淋巴结转移的患者低于有淋巴结转移的患者[(206.93±24.25)U/ml比(287.49±16.64)U/ml、(3.38±0.49)比(5.09±0.73)],且两指标水平与组织分化程度(r=-0.698、-0.533)呈负相关,与临床分期(r=0.742、0.659)、淋巴结转移(r=0.701、0.634)、疾病转归(r=0.588、0.719)均呈正相关(均P<0.05)。入院时、术后1周血清CA19-9水平、NLR联合预测胆囊癌患者转归不良的曲线下面积(area under the curve,AUC)分别为0.776(95%CI 0.718~0.839)、0.834(95%CI 0.768~0.906),最佳预测灵敏度分别为87.10%、93.55%,最佳预测特异度分别为68.29%、73.17%。结论CA19-9、NLR在胆囊癌根治术后转归不良患者血清中表达上调,两指标与临床病理参数及疾病转归均有一定相关性。两者联合检测对转归情况具有一定预测价值,可作为临床预测根治术后患者转归情况的辅助指标。展开更多
文摘BACKGROUND:CA19-9 is a carbohydrate tumor-associated antigen which is frequently upregulated in pancreatobiliary neoplasia.However,it may also be elevated in patients with jaundice in the absence of a tumor due to biliary obstruction,and in other non-hepato-pancreatico-biliary conditions.This study aimed to evaluate whether CA19-9 levels could accurately differentiate between benign and malignant pancreatobiliary disease.METHODS:All patients referred to a single surgeon for investigation of pancreaticobiliary disease in 2003 in whom a firm diagnosis had been established were included.For malignant disease,a histological diagnosis was required but for benign disease a firm radiological diagnosis was deemed adequate.The patients were divided into 4 categories:pancreatic adenocarcinoma(PCa);cholangiocarcinoma(CCa);chronic pancreatitis(CP)and biliary calculous disease(Calc).Bilirubin and alkaline phosphatase levels corresponding to the point of assessment of CA19-9 were also noted.RESULTS:Final diagnoses were made of pancreatic adenocarcinoma(PCa,n=73),cholangiocarcinoma(CCa,n=19),ampullary carcinoma(Amp,n=7),neuroendocrine carcinoma(Neu,n=4),duodenal carcinoma(Duo,n=3),chronic pancreatitis(CP,n=115),and biliary calculous disease(Calc,n=27).Median CA19-9 levels(U/ml)were:PCa,653;CCa,408;Duo,403;Calc,27;CP,19;Neu,10.5;Amp,8(reference range:0-37).The CA19-9 levels were significantly greater for malignant than for benign disease,could differentiate PCa from CCa/Duo,and were significantly higher in unresectable than in resectable PCa.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)for CA19-9 were 84.9%,69.7%,67.7%and 86.1%,respectively.A ROC analysis provided an area under the curve for CA19-9 of 0.871(0.820-0.922),giving an optimal CA19-9 of 70.5 U/ml for differentiating benign from malignant pathology.Using this cut-off,the sensitivity was 82.1%,while specificity,PPV and NPV improved to 85.9%,81.3%and 86.5%,respectively.When standard radiology was included(US/ CT/MRCP)in the decision process,the results improved to 97.2%,88.7%,86.6%,and 97.7%.For benign disease,the CA19-9 correlated directly with the serum bilirubin,but for malignant disease,CA19-9 levels were elevated independent of the bilirubin level.CONCLUSIONS:CA19-9 is useful in the differentiation of pancreatobiliary disease and when using an optimized cut-off and combining with routine radiology,the diagnostic yield is improved significantly,thus stressing the importance of a multi-disciplinary approach to pancreatobiliary disease.
基金Natural Science Foundation of Chongqing,China,No.cstc2021jcyj-msxmX0501Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2022QNXM074.
文摘BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a common cancer with increasing morbidity and mortality due to changes of social environment.AIM To evaluate the significance of serum carbohydrate antigen 19-9(CA19-9)and tumor size changes pre-and post-neoadjuvant therapy(NAT).METHODS This retrospective study was conducted at the Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment,Chongqing University Cancer Hospital.This study specifically assessed CA19-9 levels and tumor size before and after NAT.RESULTS A total of 156 patients who completed NAT and subsequently underwent tumor resection were included in this study.The average age was 65.4±10.6 years and 72(46.2%)patients were female.Before survival analysis,we defined the post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level as the CA19-9 ratio(CR).The patients were divided into three groups:CR<0.5,CR>0.5 and<1 and CR>1.With regard to tumor size measured by both computed tomography and magnetic resonance imaging,we defined the post-NAT tumor size/pre-NAT tumor size as the tumor size ratio(TR).The patients were then divided into three groups:TR<0.5,TR>0.5 and<1 and TR>1.Based on these groups divided according to CR and TR,we performed both overall survival(OS)and disease-free survival(DFS)analyses.Log-rank tests showed that both OS and DFS were significantly different among the groups according to CR and TR(P<0.05).CR and TR after NAT were associated with increased odds of achieving a complete or near-complete pathologic response.Moreover,CR(hazard ratio:1.721,95%CI:1.373-3.762;P=0.006),and TR(hazard ratio:1.435,95%CI:1.275-4.363;P=0.014)were identified as independent factors associated with OS.CONCLUSION This study demonstrated that post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with OS in patients with PDAC who received NAT and subsequent surgical resection.
文摘目的探讨糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)在胆囊癌根治手术后患者疾病转归中的临床意义。方法选取2015年1月至2021年12月于临沂市中心医院行胆囊癌根治术且均完成1年随访的72例胆囊癌患者为胆囊癌组,其中,男39例,女33例,年龄(63.19±3.85)岁。根据1∶1配对原则,另选取同期72例胆囊息肉患者为对照组,其中,男37例,女35例,年龄(62.54±3.52)岁。比较两组入院时血清CA19-9水平、NLR,比较入院时、术后1周不同疾病转归胆囊癌患者血清CA19-9水平、NLR,比较不同病理学参数胆囊癌患者血清CA19-9水平、NLR。Spearman分析入院时血清CA19-9水平、NLR与病理学参数及疾病转归的相关性。采用受试者操作特征曲线(receiver operating characteristic curve,ROC)分析入院时、术后1周血清CA19-9水平、NLR联合检测对胆囊癌患者转归不良的预测价值。结果入院时,胆囊癌组血清CA19-9水平、NLR均高于对照组[(237.14±38.41)U/ml比(31.87±6.43)U/ml、(4.02±1.25)比(1.84±0.43);均P<0.05]。转归不良患者入院时、术后1周血清CA19-9水平、NLR均高于转归良好患者[(261.71±25.33)U/ml比(218.56±24.52)U/ml、(4.73±1.02)比(3.48±0.75),(181.64±28.58)U/ml比(85.43±12.19)U/ml、(3.37±0.48)比(2.24±0.53);均P<0.05]。不同病理参数胆囊癌患者血清CA19-9水平、NLR比较:中高分化患者低于低分化患者[(208.41±22.83)U/ml比(294.60±23.18)U/ml、(3.14±0.47)比(5.78±0.69)],Ⅰ~Ⅱ期患者低于Ⅲ~Ⅳ期患者[(188.43±25.63)U/ml比(276.11±23.08)U/ml、(2.95±0.57)比(4.88±0.64)],无淋巴结转移的患者低于有淋巴结转移的患者[(206.93±24.25)U/ml比(287.49±16.64)U/ml、(3.38±0.49)比(5.09±0.73)],且两指标水平与组织分化程度(r=-0.698、-0.533)呈负相关,与临床分期(r=0.742、0.659)、淋巴结转移(r=0.701、0.634)、疾病转归(r=0.588、0.719)均呈正相关(均P<0.05)。入院时、术后1周血清CA19-9水平、NLR联合预测胆囊癌患者转归不良的曲线下面积(area under the curve,AUC)分别为0.776(95%CI 0.718~0.839)、0.834(95%CI 0.768~0.906),最佳预测灵敏度分别为87.10%、93.55%,最佳预测特异度分别为68.29%、73.17%。结论CA19-9、NLR在胆囊癌根治术后转归不良患者血清中表达上调,两指标与临床病理参数及疾病转归均有一定相关性。两者联合检测对转归情况具有一定预测价值,可作为临床预测根治术后患者转归情况的辅助指标。
