目的 探讨血清学肿瘤指标CA19-9及CA125升高程度与胰腺导管腺癌术前可切除性评估的关系。方法 回顾性分析 2009年1月至2015年12月于我院病理诊断为胰腺导管腺癌,术前影像学检查诊断肿瘤可切除病人行手术441例病人的临床资料。将病人按术中实际完成R0切除分为可切除组及不可切除组。对两组病人术前CA19-9及CA125进行比较分析。结果 CA19-9、CA125升高水平在可切除组与不可切除组之间差异有显著统计学意义（P<0.001）。将直接胆红素>34.2 μmol/L病人的CA19-9校正后,两组间CA19-9差异仍有显著统计学意义（P<0.001）。经过Logistic多因素分析筛选及受试者工作曲线后选择CA19-9（截断值=582.10 U/mL,校正后CA19-9截断值=449.70 U/mL）及CA125（截断值=41.45 U/mL）作为胰腺导管腺癌术前肿瘤可切除性的预测指标。结论 胰腺导管腺癌术前血清CA19-9及CA125升高水平可作为肿瘤可切除性的辅助预测指标,高于截断值的病人可能无法施行R0切除。
Objective To investigate the effect of increase extent of serum CA19-9 and CA125 in predicting resectability of pancreatic ductal adenocarcinoma preoperatively. Methods From January 2009 to December 2015, the clinical data of 441 patients with pancreatic ductal adenocarcinoma who were diagnosed pathologically and were evaluated to be resectable by radiology in our hospital were retrospectively analyzed. Patients were divided into resectable group and non-resectable group according to R0 resection. Preoperative serologic tumor markers including CA 19-9 and CA 125 in 2 groups were analyzed. Results There was significant statistical difference in CA19-9 and CA125 between resectable group and non-resectable group (P< 0.001). After correction of CA19-9 in the patients with direct bilirubin higher than 34.2 μmol/L, significant statistical difference in CA19-9 between two groups was still present (P< 0.001). Logistics multiple regression analysis and ROC curve showed that CA19-9 (cut-off= 582.10 U /mL, and adjusted CA19-9 cut-off= 449.70 U/mL) and CA125 (cut-off= 41.45 U/mL) were selected as predicting markers in resectability of pancreatic ductal adenocarcinoma. Conclusions Preoperative increase extent of CA19-9 and CA125 could assist to predict resectability of pancreatic ductal adenocarcinoma. The patients will have no chance of R0 resection when tumor markers increase more than cut-off value.
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