临界可切除胰腺癌的肿瘤标志物检测_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 牛强 , 侯克柱

上海杨浦区市东医院外一科（上海 200438）;

Corresponding author：

牛强, Email: shnqhospital@126.com

Keywords：

胰腺癌; 可切除性; 肿瘤标志物

DOI：

10.7507/1007-9424.20160258

Video：

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目的研究临界可切除胰腺癌的肿瘤标志物的临床特点。方法回顾性分析我院2012年1月至2015年12月期间收治的52例胰腺癌患者中的20例临界可切除胰腺癌患者术前CA19-9、CA125及CEA水平，并与不可切除胰腺癌（23例）、可切除胰腺癌（9例）患者术前的肿瘤标志物水平进行比较。结果临界可切除胰腺癌患者血清中的CA19-9（U/mL）、CA125（U/mL）及CEA（μg/L）水平均明显低于不可切除胰腺癌患者（278.5±23.9比546.2±34.8，P＜0.05；125.3±19.6比217.8±24.9，P＜0.05；11.6±2.5比19.4±3.9，P＜0.05），但明显高于可切除胰腺癌患者（278.5±23.9比131.4±25.6，P＜0.05；125.3±19.6比97.8±19.9，P＜0.05；11.6±2.5比7.1±3.0，P＜0.05）。临界可切除胰腺癌患者的术后生存时间（月）明显长于不可切除胰腺癌患者（26.9±4.8比11.5±7.2，P＜0.05），与可切除胰腺癌患者比较差异无统计学意义（26.9±4.8比28.5±3.2，P＞0.05）。临界可切除胰腺癌患者术后发生并发症5例，其中轻、重度胰漏4例，消化道大出血1例，所有并发症通过引流、抑制胰酶分泌、输血、营养支持等保守治疗治愈，无手术导致的死亡。可切除胰腺癌患者术后发生并发症3例，其中胆汁漏1例，胰漏1例，肠梗阻1例，均保守治疗治愈。结论临界可切除胰腺癌患者术前血清CA19-9、CA125及CEA水平与不可切除胰腺癌患者和可切除胰腺癌患者有一定的差异，具有与影像学特点相对应的临床特点，结合术前MDCT结果可辅助判别胰腺肿瘤手术切除可能，减少不必要的剖腹探查。

Citation： 牛强, 侯克柱. 临界可切除胰腺癌的肿瘤标志物检测. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(8): 992-994. doi: 10.7507/1007-9424.20160258 Copy

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4.	中华医学会外科学分会胰腺外科学组.胰腺癌诊治指南(2014).中华普通外科杂志, 2015, 30(1):73-79.
5.	Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer:the CONKO-001 randomized trial. JAMA, 2013, 310(14):1473-1481.
6.	Delpero JR, Bachellier P, Regenet N, et al. Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma:a French multicentre prospective evaluation of resection margins in 150 evaluable specimens. HPB (Oxford), 2014, 16(1):20-33.
7.	Mahipal A, Frakes J, Hoffe S, et al. Management of borderline resectable pancreatic cancer. World J Gastrointest Oncol, 2015, 7(10):241-249.
8.	Rückert F, Distler M, Ollmann D, et al. Retrospective analysis of survival after resection of pancreatic renal cell carcinoma metastases. Int J Surg, 2016, 26:64-68.
9.	Butler JR, Ahmad SA, Katz MH, et al. A systematic review of the role of periadventitial dissection of the superior mesenteric artery in affecting margin status after pancreatoduodenectomy for pancreatic adenocarcinoma. HPB (Oxford), 2016, 18(4):305-311.
10.	Poruk KE, Gay DZ, Brown K, et al. The clinical utility of CA 19-9 in pancreatic adenocarcinoma:diagnostic and prognostic updates. Curr Mol Med, 2013, 13(3):340-351.
11.	Distler M, Pilarsky E, Kersting S, et al. Preoperative CEA and CA 19-9 are prognostic markers for survival after curative resection for ductal adenocarcinoma of the pancreas-a retrospective tumor marker prognostic study. Int J Surg, 2013, 11(10):1067-1072.
12.	Ferrone CR, Finkelstein DM, Thayer SP, et al. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol, 2006, 24(18):2897-2902.
13.	Humphris JL, Chang DK, Johns AL, et al. The prognostic and predictive value of serum CA19.9 in pancreatic cancer. Ann Oncol, 2012, 23(7):1713-1722.
14.	Hartwig W, Strobel O, Hinz U, et al. CA19-9 in potentially resectable pancreatic cancer:perspective to adjust surgical and perioperative therapy. Ann Surg Oncol, 2013, 20(7):2188-2196.
15.	Liu L, Xu H, Wang W, et al. A preoperative serum signature of CEA+/CA125+/CA19-9≥1 000 U/mL indicates poor outcome to pancreatectomy for pancreatic cancer. Int J Cancer, 2015, 136(9):2216-2227.
16.	Liu L, Xu HX, Wang WQ, et al. Serum CA125 is a novel predictive marker for pancreatic cancer metastasis and correlates with the metastasis-associated burden. Oncotarget, 2016, 7(5):5943-5956.
17.	李宁, 沈世强, 刘建超.血清CA19-9、CA242、CEA及CA125在胰腺癌诊断和预后中的价值.中国普外基础与临床杂志, 2011, 18(3):300-304.
18.	Al-Hawary MM, Francis IR, Chari ST, et al. Pancreatic ductal adenocarcinoma radiology reporting template:consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology, 2014, 146(1):291-304.e1.
19.	Katz MH, Marsh R, Herman JM, et al. Borderline resectable pancreatic cancer:need for standardization and methods for optimal clinical trial design. Ann Surg Oncol, 2013, 20(8):2787-2795.

1. Clancy TE. Surgery for pancreatic cancer. Hematol Oncol Clin North Am, 2015, 29(4):701-716.
2. 彭承宏.重视胰腺癌术前手术可切除性评估.外科理论与实践, 2007, 12(3):196-198.
3. Callery MP, Chang KJ, Fishman EK, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer:expert consensus statement. Ann Surg Oncol, 2009, 16(7):1727-1733.
4. 中华医学会外科学分会胰腺外科学组.胰腺癌诊治指南(2014).中华普通外科杂志, 2015, 30(1):73-79.
5. Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer:the CONKO-001 randomized trial. JAMA, 2013, 310(14):1473-1481.
6. Delpero JR, Bachellier P, Regenet N, et al. Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma:a French multicentre prospective evaluation of resection margins in 150 evaluable specimens. HPB (Oxford), 2014, 16(1):20-33.
7. Mahipal A, Frakes J, Hoffe S, et al. Management of borderline resectable pancreatic cancer. World J Gastrointest Oncol, 2015, 7(10):241-249.
8. Rückert F, Distler M, Ollmann D, et al. Retrospective analysis of survival after resection of pancreatic renal cell carcinoma metastases. Int J Surg, 2016, 26:64-68.
9. Butler JR, Ahmad SA, Katz MH, et al. A systematic review of the role of periadventitial dissection of the superior mesenteric artery in affecting margin status after pancreatoduodenectomy for pancreatic adenocarcinoma. HPB (Oxford), 2016, 18(4):305-311.
10. Poruk KE, Gay DZ, Brown K, et al. The clinical utility of CA 19-9 in pancreatic adenocarcinoma:diagnostic and prognostic updates. Curr Mol Med, 2013, 13(3):340-351.
11. Distler M, Pilarsky E, Kersting S, et al. Preoperative CEA and CA 19-9 are prognostic markers for survival after curative resection for ductal adenocarcinoma of the pancreas-a retrospective tumor marker prognostic study. Int J Surg, 2013, 11(10):1067-1072.
12. Ferrone CR, Finkelstein DM, Thayer SP, et al. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol, 2006, 24(18):2897-2902.
13. Humphris JL, Chang DK, Johns AL, et al. The prognostic and predictive value of serum CA19.9 in pancreatic cancer. Ann Oncol, 2012, 23(7):1713-1722.
14. Hartwig W, Strobel O, Hinz U, et al. CA19-9 in potentially resectable pancreatic cancer:perspective to adjust surgical and perioperative therapy. Ann Surg Oncol, 2013, 20(7):2188-2196.
15. Liu L, Xu H, Wang W, et al. A preoperative serum signature of CEA+/CA125+/CA19-9≥1 000 U/mL indicates poor outcome to pancreatectomy for pancreatic cancer. Int J Cancer, 2015, 136(9):2216-2227.
16. Liu L, Xu HX, Wang WQ, et al. Serum CA125 is a novel predictive marker for pancreatic cancer metastasis and correlates with the metastasis-associated burden. Oncotarget, 2016, 7(5):5943-5956.
17. 李宁, 沈世强, 刘建超.血清CA19-9、CA242、CEA及CA125在胰腺癌诊断和预后中的价值.中国普外基础与临床杂志, 2011, 18(3):300-304.
18. Al-Hawary MM, Francis IR, Chari ST, et al. Pancreatic ductal adenocarcinoma radiology reporting template:consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology, 2014, 146(1):291-304.e1.
19. Katz MH, Marsh R, Herman JM, et al. Borderline resectable pancreatic cancer:need for standardization and methods for optimal clinical trial design. Ann Surg Oncol, 2013, 20(8):2787-2795.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

临界可切除胰腺癌的肿瘤标志物检测

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