Carbohydrate antigen 19-9 level to total tumor volume as a predictor of pancreatic carcinoma recurrence and long-term prognosis after curative resection

doi:10.3877/cma.j.issn.1674-0793.2021.02.011

Abstract

Abstract:

Objective

To evaluate the effect of carbohydrate antigen 19-9 (CA19-9)/total tumor volume (TTV), the ratio of CA19-9 to TTV, as a prognostic marker on tumor recurrence and long-term survival in patients with pancreatic ductal adenocarcinoma (PDAC) following pancreaticoduodenectomy (PD).

Methods

The data of 203 patients who underwent PD for PDAC in Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2011 to December 2019 were analyzed. Univariate and multivariate analyses were performed of the clinicopathological data to screen out the risk factors affecting long-term prognosis of PDAC. CA19-9/TTV was calculated according to preoperative CA19-9 and TTV, and the ROC curve was drawn based on CA19-9/TTV and 1-year survival, so as to determine the optimal cut-off value of CA19-9/TTV and group criterion. The differences of clinicopathological data and postoperative complications between the two groups were compared to explore their relationship with long-term prognosis in patients with PDAC undergoing PD.

Results

The median overall survival (OS) was 18 months, and the 1-, 3-, and 5-year OS rates were 64.1%, 25.6% and 15.2%, respectively. Tumor differentiation and CA19-9/TTV were independent risk factors for long-term prognosis of PDAC (P=0.002, 0.005). The best cut-off value of ROC curve was 5.62 (area under curve, 0.633; 95% CI: 0.548-0.718). Patients with CA19-9/TTV≤5.62 were labeled as Group 1, and others were Group 2. There was no significant difference in clinicopathological data between the two groups. The median OS in Group 1 and Group 2 was 26 and 15 months respectively, and the 1-, 3- and 5-year OS rates were 82.7%, 40.8%, 24.8% and 57.5%, 19.0%, 11.2%, respectively (P=0.002).

Conclusion

CA19-9/TTV is an independent risk factor for the prognosis of PDAC after PD, which may be a new marker for lower survival benefits.

Key words: Pancreatic neoplasms, Pancreaticoduodenectomy, Carbohydrate antigen 19-9, Total tumor volume, Prognosis

Wenli Xu, Fangfei Wang, Zhangyong Ren, Shaocheng Lyu, Xinxue Zhang, Lixin Li, Qiang He. Carbohydrate antigen 19-9 level to total tumor volume as a predictor of pancreatic carcinoma recurrence and long-term prognosis after curative resection[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(02): 131-136.

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References 20

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项目		CA19-9/TTV≤5.62组	CA19-9/TTV>5.62组	u/t/χ²值	P值
例数		61	142
性别(例)				0.325	0.429
	男	32	83
	女	29	59
年龄(岁) ^a		63.7±9.2	61.0.0±11.0	0.005	0.087
糖尿病(例)				0.325	0.430
	有	18	50
	无	43	92
术前减黄(例)				0.067	0.795
	有	13	28
	无	48	114
总胆红素(μmol/L) ^b		16.8 (9.1, 80.8)	20.0 (11.9, 88.9)	1.183	0.237
肿瘤分化(例)				0.050	0.823
	低	19	42
	中-高	42	100
术中出血量(ml) ^b		500.0 (300.0, 500.0)	500.0 (400.0, 800.0)	1.170	0.242
术中输血(例)				0.059	0.808
	有	23	51
	无	38	91
手术时间(h) ^b		9 (7, 11)	10 (8, 12)	0.036	0.971
淋巴结转移(例)				0.338	0.561
	有	40	87
	无	21	55
切除性质(例)				0.532	0.466
	R0	58	131
	R1	3	11
术后化疗(例)				0.125	0.724
	有	20	43
	无	41	99
神经侵犯(例)				0.495	0.481
	有	57	136
	无	4	6
肿瘤直径(cm) ^a		3.2±0.9	3.4±1.4	0.216	0.544

项目		CA19-9/TTV≤5.62组	CA19-9/TTV>5.62组	u/t/χ²值	P值
例数		61	142
性别(例)				0.325	0.429
	男	32	83
	女	29	59
年龄(岁) ^a		63.7±9.2	61.0.0±11.0	0.005	0.087
糖尿病(例)				0.325	0.430
	有	18	50
	无	43	92
术前减黄(例)				0.067	0.795
	有	13	28
	无	48	114
总胆红素(μmol/L) ^b		16.8 (9.1, 80.8)	20.0 (11.9, 88.9)	1.183	0.237
肿瘤分化(例)				0.050	0.823
	低	19	42
	中-高	42	100
术中出血量(ml) ^b		500.0 (300.0, 500.0)	500.0 (400.0, 800.0)	1.170	0.242
术中输血(例)				0.059	0.808
	有	23	51
	无	38	91
手术时间(h) ^b		9 (7, 11)	10 (8, 12)	0.036	0.971
淋巴结转移(例)				0.338	0.561
	有	40	87
	无	21	55
切除性质(例)				0.532	0.466
	R0	58	131
	R1	3	11
术后化疗(例)				0.125	0.724
	有	20	43
	无	41	99
神经侵犯(例)				0.495	0.481
	有	57	136
	无	4	6
肿瘤直径(cm) ^a		3.2±0.9	3.4±1.4	0.216	0.544

项目		例数	1年无瘤生存率(%)	3年无瘤生存率(%)	5年无瘤生存率(%)	χ²值	P值
性别						0.002	0.962
	男	112	63.5	28.5	17.6
	女	88	67.2	22.1	11.8
年龄(岁)						0.672	0.413
	>65	83	60.5	28.7	15.2
	≤65	117	68.3	23.1	15.2
糖尿病						0.962	0.328
	是	67	62.6	22.1	11.7
	否	133	66.4	27.9	17.9
术前胆红素(μmol/L)						0.801	0.370
	≤21	92	65.4	32.1	22.1
	>21	108	65.1	20.3	9.1	0.100	0.751
术前CEA(ng/ml)
	<5	149	64.6	25.7	16.5
	≥5	51	66.5	26.2	14.8
切除性质						0.010	0.920
	R0	187	66.2	25.7	15.6
	R1	13	50.0	25.0	12.5
神经侵犯						5.414	0.020
	有	191	63.5	23.9	13.4
	无	9	100.0	68.6	68.6
淋巴结转移						7.548	0.006
	有	126	57.2	20.6	11.3
	无	74	78.7	36.6	23.8
肿瘤直径(cm)						1.679	0.195
	≤2	38	75.5	27.1	21.7
	>2	162	62.8	26.0	15.1
病理分化						11.186	<0.001
	低	50	47.6	10.8	7.2
	中-高	150	71.1	31.2	18.3
术后化疗						0.063	0.802
	是	62	70.2	18.6	12.8
	否	138	62.8	29.8	16.6
TNM分期						6.487	0.039
	Ⅰ	56	81.2	37.2	19.5
	Ⅱ	93	61.2	22.7	18.2
	Ⅲ	51	55.3	20.1	9.1
CA19-9/TTV						7.042	<0.001
	≤5.62	61	81.6	42.8	26.0
	>5.62	139	57.5	19.0	11.2
术中输血						0.316	0.570
	有	73	57.8	36.0	18.0
	无	127	69.3	18.7	13.1
术中出血(ml)						2.689	0.816
	≥800	85	66.2	33.8	18.0
	<800	115	64.2	20.2	13.8

项目		例数	1年无瘤生存率(%)	3年无瘤生存率(%)	5年无瘤生存率(%)	χ²值	P值
性别						0.002	0.962
	男	112	63.5	28.5	17.6
	女	88	67.2	22.1	11.8
年龄(岁)						0.672	0.413
	>65	83	60.5	28.7	15.2
	≤65	117	68.3	23.1	15.2
糖尿病						0.962	0.328
	是	67	62.6	22.1	11.7
	否	133	66.4	27.9	17.9
术前胆红素(μmol/L)						0.801	0.370
	≤21	92	65.4	32.1	22.1
	>21	108	65.1	20.3	9.1	0.100	0.751
术前CEA(ng/ml)
	<5	149	64.6	25.7	16.5
	≥5	51	66.5	26.2	14.8
切除性质						0.010	0.920
	R0	187	66.2	25.7	15.6
	R1	13	50.0	25.0	12.5
神经侵犯						5.414	0.020
	有	191	63.5	23.9	13.4
	无	9	100.0	68.6	68.6
淋巴结转移						7.548	0.006
	有	126	57.2	20.6	11.3
	无	74	78.7	36.6	23.8
肿瘤直径(cm)						1.679	0.195
	≤2	38	75.5	27.1	21.7
	>2	162	62.8	26.0	15.1
病理分化						11.186	<0.001
	低	50	47.6	10.8	7.2
	中-高	150	71.1	31.2	18.3
术后化疗						0.063	0.802
	是	62	70.2	18.6	12.8
	否	138	62.8	29.8	16.6
TNM分期						6.487	0.039
	Ⅰ	56	81.2	37.2	19.5
	Ⅱ	93	61.2	22.7	18.2
	Ⅲ	51	55.3	20.1	9.1
CA19-9/TTV						7.042	<0.001
	≤5.62	61	81.6	42.8	26.0
	>5.62	139	57.5	19.0	11.2
术中输血						0.316	0.570
	有	73	57.8	36.0	18.0
	无	127	69.3	18.7	13.1
术中出血(ml)						2.689	0.816
	≥800	85	66.2	33.8	18.0
	<800	115	64.2	20.2	13.8

变量	P值	RR	95% CI	Wald	SE
淋巴结转移	0.916	0.969	0.536~1.705	0.011	0.302
神经侵犯	0.172	0.437	0.134~1.432	1.867	0.605
TNM分期	0.145	1.307	0.912~1.873	2.124	0.184
肿瘤分化	0.002	1.790	1.231~2.605	9.268	0.191
CA19-9/TTV	0.005	1.757	1.182~2.612	7.775	0.202

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