CA19-9用于检测胰腺癌的复发。,Scientific Reports

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CA19-9用于检测胰腺癌的复发。
Scientific Reports ( IF 3.8 ) Pub Date : 2020-01-28 , DOI: 10.1038/s41598-020-57930-x
Azadeh Azizian ₁ , Felix Rühlmann ₁ , Tanja Krause ₁ , Markus Bernhardt ₁ , Peter Jo ₁ , Alexander König ₂ , Mathias Kleiß ₃ , Andreas Leha ₄ , Michael Ghadimi ₁ , Jochen Gaedcke ₁

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胰腺癌患者定期测量CA19-9值。当然，CA19-9阴性患者的假阴性结果和良性胰腺胆道疾病的假阳性结果削弱了其作为生物标志物的潜力。但是，对于检测PDAC复发，CA19-9可能起重要作用。这项研究的目的是分析CA19-9检测胰腺癌复发的准确性。所有纳入的患者均在哥廷根大学医学中心或卡塞尔DRK-Kliniken Nordhessen的跨学科肿瘤与肺病学系接受了治疗。我们回顾性分析了训练组和验证组中93例胰腺癌患者的数据。比较术前和术后CA19-9值和成像技术结果。我们进行了ROC分析。用CA19-9纵向测量的随机效应模型和生存数据的Cox比例风险模型之间的联合模型研究了纵向测量的CA19-9值与复发之间的关联。在测试集中（n = 93位患者），中位随访时间为644天（22个月）。总体而言，有71位患者（76.3％）在随访期间出现了复发。CA19-9值＜10kU / l的患者被视为CA19-9阴性患者（n = 11），并排除在进一步分析之外。在其余的患者中，大约60％的患者在通过成像技术检测到复发之前显示出CA19-9明显升高。CA19-9值升高了2.45倍，复发预测率达到90％的阳性预测值。在验证集中，2。CA19-9值升高45倍，表明复发率达90％，敏感性和83.33％特异性，曲线下面积为95％。基于随访护理期间测得的CA19-9值，联合模型可估算无复发患者的无复发生存率。CA19-9升高是PDAC复发的早期可靠信号。由于在CA19-9阳性患者中具有非常高的准确性，因此即使没有成像技术的相关因素，也应考虑将CA19-9用于治疗决策。使用联合模型，可以对根治性治疗后的PDAC患者进行随访。联合模型估计了无复发患者无复发生存的可能性。CA19-9升高是PDAC复发的早期可靠信号。由于在CA19-9阳性患者中具有非常高的准确性，因此即使没有成像技术的相关因素，也应考虑将CA19-9用于治疗决策。使用联合模型，可以对根治性治疗后的PDAC患者进行随访。联合模型估计了无复发患者无复发生存的可能性。CA19-9升高是PDAC复发的早期可靠信号。由于在CA19-9阳性患者中具有非常高的准确性，因此即使没有成像技术的相关因素，也应考虑将CA19-9用于治疗决策。使用联合模型，可以对根治性治疗后的PDAC患者进行随访。

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CA19-9 for detecting recurrence of pancreatic cancer.

CA19-9 values are regularly measured in patients with pancreatic cancer. Certainly, its potential as a biomarker has been compromised by false negative results in CA19-9 negative patients and false positive results in benign pancreatico-biliary diseases. For detection of PDAC recurrence, however, CA19-9 might play an important role. The aim of this study is to analyze the accuracy of CA19-9 for detecting recurrence of pancreatic cancer. All included patients were treated either at the University Medical Center Goettingen, or at the Department of Interdisciplinary Oncology and Pneumonology, DRK-Kliniken Nordhessen, Kassel. We analyzed data of 93 patients with pancreatic cancer in the training set and 41 in the validation set, both retrospectively. Pre- and postoperative CA19-9 values and results of imaging techniques were compared. We performed ROC-analysis. The association between longitudinally measured CA19-9 values and relapse was studied with a joint model between a random effects model for the longitudinal CA19-9 measurements and a Cox proportional hazards models for the survival data. In the test set (n = 93 patients) the median follow-up time was 644 days (22 months). Overall, 71 patients (76.3%) developed recurrence during follow-up. Patients with CA19-9 values of <10kU/l were considered as CA19-9 negative patients (n = 11) and excluded from further analysis. Among the rest, approximately 60% of the patients showed significantly elevated CA19-9 prior to detection of recurrence by imaging techniques. Recurrence was shown by 2.45 times elevated CA19-9 values with 90% positive predictive value. In the validation set, 2.45 times elevated CA19-9 values showed recurrence with 90% sensitivity and 83,33% specificity, with an area under the curve of 95%. Based on measured CA19-9 values during follow-up care, the joint model estimates in recurrence-free patients the probability of recurrence-free survival. CA19-9 elevation is an early and reliable sign for PDAC recurrence. On the strength of a very high accuracy in CA19-9 positive patients, it should be considered to use CA19-9 for therapy decision even without a correlate of imaging technics. Using the joint model, follow-up care of PDAC patients after curative therapy can be stratified.

更新日期：2020-01-29

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