糖链抗原19-9对可切除肝门部胆管癌患者预后及早期复发的预测价值

查育锋; 何晓虎; 田勉; 高军; 王刚

doi:10.3969/j.issn.1001-5256.2018.05.024

糖链抗原19-9对可切除肝门部胆管癌患者预后及早期复发的预测价值

DOI: 10.3969/j.issn.1001-5256.2018.05.024

陕西中医药大学第二附属医院肝胆普外科

详细信息

中图分类号: R735.8
计量
- 文章访问数: 599
- HTML全文浏览量: 49
- PDF下载量: 68
- 被引次数: 0
出版历程
- 收稿日期: 2017-11-06
- 出版日期: 2018-05-20

Value of preoperative and postoperative carbohydrate antigen 19-9 levels in predicting prognosis and early recurrence in patients with hilar cholangiocarcinoma

Department of General Hepatobiliary Surgery, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine

摘要

摘要: 目的探讨手术前后肿瘤标志物糖链抗原19-9（CA19-9）水平对可切除肝门部胆管癌（HCCA）患者生存预后及早期复发的预测作用。方法选择2001年1月-2013年12月于陕西中医药大学第二附属医院接受根治性切除术治疗的HCCA患者80例。根据患者病历信息及检查资料,记录HCCA患者年龄、性别等临床资料。应用电化学发光法测定血清CA19-9水平。术前、术后CA19-9截断点预测HCCA患者生存率的截断点分为≤100 U/ml、>100 U/ml组,≤150 U/ml、>150 U/ml组,≤200 U/ml、>200 U/ml组,≤400 U/ml、>400 U/ml组。采用Kaplan-Meier法比较CA19-9≤150 U/ml和CA19-9>150 U/ml组,CA19-9升高、CA19-9降低≤50%和CA19-9降低>50%组生存率差异。应用单因素、多因素非条件logistic回归分析手术前后CA19-9水平与临床资料的关系。计量资料2组间比较采用t检验;计数资料组间比较采用χ2检验。结果术前不同CA19-9截断点100 U/ml、150 ...
- 胆管肿瘤 /
- CA-19-9抗原 /
- 预后 /
- 复发
Abstract: Objective To investigate the value of preoperative and postoperative carbohydrate antigen 19-9 ( CA19-9) levels in predicting the prognosis and early recurrence of patients with hilar cholangiocarcinoma ( HCCA) . Methods A total of 80 patients with HCCA who underwent radical resection in The Second Affiliated Hospital of Shaanxi University of Chinese Medicine from January 2001 to December2013 were enrolled. According to their medical records and examination results, the clinical data including age and sex were recorded. Electrochemical luminescence was used to measure the serum level of CA19-9. The cut-off points of preoperative and postoperative CA19-9 levels in predicting the survival rate of HCCA patients were divided into ≤100 U/ml and > 100 U/ml groups, ≤150 U/ml and > 150 U/ml groups, ≤200 U/ml and > 200 U/ml groups, and ≤400 U/ml and > 400 U/ml groups. The Kaplan-Meier method was used to compare the survival rate between CA19-9 ≤150 U/ml group and CA19-9 > 150 U/ml group, as well as between increased CA19-9 group, ≤50% reduction in CA19-9 group, and > 50% reduction in CA19-9 group. Univariate and multivariate non-conditional logistic regression analyses were used to analyze the association of preoperative and postoperative CA19-9 levels with clinical data. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results There was a significant difference in the prediction of survival time of HCCA patients undergoing radical resection between the cut-off points of preoperative CA19-9 of 100, 150, 200, and 400 U/ml ( t = 2. 85, 3. 66, 2. 84, and 2. 55, P < 0. 05) , as well as between the cut-off points of postoperative CA19-9 of 100, 150, 200, and 400 U/ml ( t = 3. 06, 4. 55, 3. 08, and 5. 15, P < 0. 05) . The Kaplan-Meier survival analysis showed that the HCCA patients undergoing radical resection with a preoperative CA19-9 level of ≤150 U/ml had a significantly higher survival rate than those with a preoperative CA19-9 level of > 150 U/ml ( P < 0. 05) ; the HCCA patients undergoing radical resection with a postoperative CA19-9 level of ≤150 U/ml had a significantly higher survival rate than those with a postoperative CA19-9 level of > 150 U/ml ( P < 0. 05) . The HCCA patients who underwent radical resection and had an increase in CA19-9 after surgery had a significantly higher survival rate than those who had a ≤50% or > 50% reduction in CA19-9 after surgery ( both P < 0. 05) .The univariate and multivariate analyses showed that in HCCA patients undergoing radical resection, the preoperative CA19-9 level was associated with lymph node metastasis and early recurrence ( both P < 0. 05) and the postoperative CA19-9 level was associated with early recurrence ( P < 0. 05) . Conclusion Preoperative and postoperative CA19-9 levels can be used to predict survival and early recurrence of patients with resectable HCCA. An increase in CA19-9 level after surgery may cause early recurrence and poor survival outcome in patients with HCCA.
- bile duct neoplasms /
- CA-19-9 antigen /
- prognosis /
- recurrence

HTML全文

参考文献(17)

[1]WANG QR, ZHANG Y, MU D, et al.Association between hematobilia and primary disease after therapeutic endoscopic retrograde cholangiopancreatography[J].J Clin Hepatol, 2017, 33 (5) :896-898. (in Chinese) 王群茹, 张勇, 牟东, 等.治疗性经内镜逆行胰胆管造影术后胆道出血与原发疾病的关系[J].临床肝胆病杂志, 2017, 33 (5) :896-898.

[2]XIANG S, WAN YL, CHEN X.Hilar cholangiocarcinoma:Controversies on the extent of surgical resection aiming at cure[J].Int J Colorectal Dis, 2015, 30 (2) :159-171.

[3]HU HJ, HUI M, TAN YQ, et al.Clinical value of preoperative serum CA 19-9 and CA 125 levels in predicting the resectability of hilar cholangiocarcinoma[J].Springerplus, 2016, 5 (1) :551-559.

[4]LI M, KAI L, QI X, et al.Percutaneous transhepatic biliary stent implantation for obstructive jaundice of perihilar cholangiocarcinoma:a prospective study on predictors of stent patency and survival in 92 patients[J].J Vasc Interv Radiol, 2016, 27 (7) :1047-1055.

[5]CUI DP, ZHANG YC, GAO SQ, et al.Value of serum carbohydrate antigens 19-9 and 24-2 in diagnosis of benign and malignant biliary tract diseases[J].J Clin Hepatol, 2016, 32 (7) :1364-1367. (in Chinese) 崔大鹏, 张迎春, 高树全, 等.血清糖链抗原19-9、糖链抗原24-2对良恶性胆道疾病的诊断价值[J].临床肝胆病杂志, 2016, 32 (7) :1364-1367.

[6]FENG F, TIAN Y, XU G, et al.Diagnostic and prognostic value of CEA, CA19-9, AFP and CA125 for early gastric cancer[J].BMC Cancer, 2017, 17 (1) :737-743.

[7] Anti-cancer Association of China.Guideline for the diagnosis and therapy of hilar cholangiocarcinoma (2015) [J].Chin J Hepatobiliary Surg, 2015, 21 (8) :505-511. (in Chinese) 中国抗癌协会.肝门部胆管癌规范化诊治专家共识 (2015) [J].中华肝胆外科杂志, 2015, 21 (8) :505-511.

[8]EBATA T, KOSUGE T, HIRANO S, et al.Proposal to modify the International Union Against Cancer staging system for perihilar cholangiocarcinomas[J].Br J Surg, 2014, 101 (2) :79-88.

[9]WANG Y, YANG H, SHEN C, et al.Surgical procedure and long-term survival of hilar cholangiocarcinoma[J].Int J Clin Exp Med, 2015, 8 (1) :1122-1128.

[10]CAI WK, LIN JJ, HE GH, et al.Preoperative serum CA19-9 levels is an independent prognostic factor in patients with resected hilar cholangiocarcinoma[J].Int J Clin Exp Pathol, 2014, 7 (11) :7890-7898.

[11]YIN XY, LIU X, CHEN W, et al.Long-term outcomes and prognostic factors of surgical resection of hilar cholangiocarcinoma[J].Chin J Dig Surg, 2016, 15 (4) :329-333. (in Chinese) 殷晓煜, 刘鑫, 陈伟, 等.肝门部胆管癌手术切除的远期疗效及预后因素分析[J].中华消化外科杂志, 2016, 15 (4) :329-333.

[12]SUI XL, TANG HH, XIAO GF, et al.Clinical efficacy and prognostic factors analysis of hilar cholangiocarcinoma in 322 patients[J].Chin J Dig Surg, 2017, 16 (4) :391-397. (in Chinese) 隋鑫磊, 汤恢焕, 肖广发, 等.322例肝门部胆管癌的临床疗效及预后因素分析[J].中华消化外科杂志, 2017, 16 (4) :391-397.

[13]LI L, WANG J, SHANG PZ.Expressions of Annexin A1 and CA19-9 in cholangiocarcinoma and their clinicopathological significance[J].China J Modern Med, 2016, 26 (10) :31-35. (in Chinese) 李辽, 王金, 尚培中.膜联蛋白A1和CA19-9在胆管癌中的表达及其临床意义[J].中国现代医学杂志, 2016, 26 (10) :31-35.

[14]HU SZ, WANG X, KONG J.Clinical data and differential diagnosis of hilar cholangiocarcinoma and hilar benign diseases[J].Chin J Bases and Clin Gen Surg, 2017, 1 (3) :343-348. (in Chinese) 胡尚志, 王鑫, 孔静.肝门胆管癌与肝门部良性疾病的临床资料比较和鉴别诊断[J].中国普外基础与临床杂志, 2017, 1 (3) :343-348.

[15]WANG JK, HU HJ, SHRESTHA A, et al.Can preoperative and postoperative CA19-9 levels predict survival and early recurrence in patients with resectable hilar cholangiocarcinoma?[J].Oncotarget, 2017, 8 (28) :45335-45344.

[16]LAI JF, XU WN, NOH SH, et al.Effect of World Health Organization (WHO) histological classification on predicting lymph node metastasis and recurrence in early gastric cancer[J].Med Sci Monit, 2016, 22 (5) :3147-3153.

[17]DEOLIVEIRA ML, CUNNINGHAM SC, CAMERON JL, et al.Cholangiocarcinoma:thirty-one-year experience with 564 patients at a single institution[J].Ann Surg, 2007, 245 (5) :755-762.

施引文献

资源附件(0)

访问统计