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糖链抗原19-9对可切除肝门部胆管癌患者生存预后及早期复发的预测价值
Value of preoperative and postoperative carbohydrate antigen 19-9 levels in predicting prognosis and early recurrence in patients with hilar cholangiocarcinoma
文章发布日期:2018年04月04日  来源:  作者:查育锋,何晓虎,田勉,等  点击次数:372次  下载次数:81次

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【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 U/ml、200 U/ml、400 U/ml预测HCCA根治性切除术患者生存时间的差异均有统计学意义(t值分别为2.85、3.66、2.84、255,P值均<0.05);术后不同CA19-9截断点100 U/ml、150 U/ml、200 U/ml、400 U/ml预测HCCA根治性切除术患者生存时间的差异均有统计学意义(t值分别为3.06、4.55、3.08、5.15,P值均<0.05)。Kaplan-Meier生存分析结果显示,术前CA19-9≤150 U/ml的HCCA根治性切除术患者生存率显著高于术前CA19-9>150 U/ml患者(P<0.05);术后CA19-9≤150 U/ml的HCCA根治性切除术患者生存率显著高于术后CA19-9>150 U/ml患者(P<0.05)。手术前后CA19-9升高的HCCA根治性切除术患者生存率显著高于手术前后CA19-9降低≤50%和CA19-9降低>50%患者(P值均<0.05)。单因素、多因素分析结果显示,HCCA根治性切除术患者术前CA19-9水平与淋巴结转移、早期复发有关(P值均<0.05);术后CA19-9水平与早期复发有关(P<0.05)。结论手术前后CA19-9水平可预测可切除HCCA患者生存及早期复发。手术前后CA19-9水平升高提示HCCA患者易早期复发及较差的生存结局。
【Abstract】:ObjectiveTo 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). MethodsA 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 December 2013 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. ResultsThere 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). ConclusionPreoperative 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.
【关键字】:胆管肿瘤; CA-19-9抗原; 预后; 复发
【Key words】:bile duct neoplasms; CA-19-9 antigen; prognosis; recurrence
【引证本文】:ZHA YF, HE XH, TIAN M, et al. Value of preoperative and postoperative carbohydrate antigen 19-9 levels in predicting prognosis and early recurrence in patients with hilar cholangiocarcinoma[J]. J Clin Hepatol, 2018, 34(5): 1046-1051. (in Chinese) 查育锋, 何晓虎, 田勉, 等. 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[J]. 临床肝胆病杂志, 2018, 34(5): 1046-1051.

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