| 郭宇,刘晨,任刚,康晓黎,李平,李晶,秦青,王颖杰,夏廷毅.血清CA19-9水平对胰腺癌高剂量少分次放疗联合化疗的预后预测作用与疗效评价[J].中华放射医学与防护杂志,2018,38(5):344-349 |
| 血清CA19-9水平对胰腺癌高剂量少分次放疗联合化疗的预后预测作用与疗效评价 |
| Serum CA19-9 as a predictive value and an effective evaluator for pancreatic cancer patients treated with hypofractionated tomotherapy combined with chemotherapy |
| 投稿时间：2018-01-12 |
| DOI：10.3760/cma.j.issn.0254-5098.2018.05.004 |
| 中文关键词: 胰腺肿瘤 放射治疗 血清CA19-9 预测 肿瘤标志物 |
| 英文关键词:Pancreatic cancer Radiotherapy Serum levels of CA19-9 Prediction Tumor marker |
| 基金项目:首都卫生发展科研专项（2014-1-5124） |
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| 中文摘要: |
| 目的 观察利用螺旋断层调强放疗技术，高剂量、少分次放疗模式联合化疗治疗胰腺癌前、后血清CA19-9水平动态变化，探讨其相应的预后、预测与疗效评价作用。方法 回顾性分析空军总医院放疗科2012年12月至2017年6月收治的75例病理诊断明确的胰腺癌患者临床资料及随访生存情况。采用Kaplan-Meier法及Log-rank检验分析放疗前及放疗后4~6周CA19-9水平变化对预后的影响。结果 全组中位生存期（MST）为13.8个月（2.0~58.0个月）。75例患者血清基线CA19-9中位水平为1 109 U/ml（4.70~70 000 U/ml），<1 109 U/ml组与≥1 109 U/ml组MST分别为14.0个月（95%CI：10.04~22.96个月）和9.0个月（95%CI：7.75~13.25个月）（χ2=6.31，P<0.05），中位无进展生存期（mPFS）分别为7.0个月（95%CI：5.58~8.42个月）和5.0个月（95%CI：3.81~6.20个月）（χ2=8.51，P<0.05）。放疗后4~6周血清CA19-9中位值为397.7 U/ml（11.02~43 250 U/ml），38例（38/49，77.6%）下降，11例（11/49，22.4%）上升，下降组、上升组MST分别为14.0个月（95%CI：7.24~20.77个月）和8.0个月（95%CI： 2.69~13.31个月）（χ2=11.19，P<0.05），mPFS分别为5.5个月（95%CI：4.05~6.95个月）和4.0个月（95%CI：1.98~6.02个月）（χ2=9.12，P<0.05）。受试者工作特征曲线（ROC）确定放疗后4~6周血清CA19-9下降程度截断值为60.9%，下降≥60.9%组与<60.9%组MST分别为33.5个月（95%CI：0.24~66.76个月）和9.0个月（95%CI：6.92~11.08个月）（χ2=13.80，P<0.05），mPFS分别为11.0个月（95%CI：3.44~18.56个月）和5.0个月（95%CI：3.91~6.09个月）（χ2=8.71，P<0.05）。结论 在胰腺癌高剂量、少分次放疗联合化疗中，基线血清CA19-9<1 109 U/ml的患者预后较好，放疗后4~6周血清CA19-9下降能及时、有效预测患者转移及生存情况，血清CA19-9下降≥60.9%的胰腺癌患者，半年内发生疾病进展可能性较低，总体预后较好。 |
| 英文摘要: |
| Objective To observe the dynamic changes of serum CA19-9 level before and after the treatment of high-dose and low-fractionated Tomotherapy combined with chemotherapy for pancreatic cancer, and explore the corresponding prognostic, predictive and therapeutic effects. Methods The clinical characteristics and the survival of 75 patients with pancreatic cancer treated in the Department of Radiotherapy of Air Force General Hospital were analyzed retrospectively from December 2012 to June 2017. The effects of baseline CA19-9 and CA19-9 level at 4-6 weeks after the radiotherapy on patient prognosis were analyzed by Kaplan-Meier method and Log-rank test retrospectively. Results The median survival time (MST) was 13.8 months (2.0-58.0 months). The baseline serum CA19-9 was 1 109 U/ml (4.70-70 000 U/ml). The MST in the <1 109 U/ml group and ≥ 1 109 U/ml group were 14.0 months(95% CI:10.04-22.96 months)and 9.0 months(95% CI:7.75-13.25 months)respectively (χ2=6.31, P<0.05). The corresponding median progression-free survival (mPFS) was 7.0 months(95% CI:5.58-8.42 months)and 5.0 months(95% CI:3.81-6.20 months)respectively (χ2=8.51, P<0.05). The median CA19-9 level at 4-6 weeks after radiotherapy was 397.7 U/ml (11.02-43 250 U/ml). A total of 38 cases (38/49, 77.6%) declined, and 11 cases (11/49, 22.4%) increased. The MST of the declined and increased groups were 14.0 months(95% CI:7.24-20.77 months)and 8.0 months(95% CI: 2.69-13.31 months)respectively (χ2=11.19, P<0.05). The corresponding mPFS were 5.5 months(95% CI:4.05-6.95 months)and 4.0 months(95% CI:1.98-6.02 months)respectively (χ2=9.12, P<0.05). The ROC curve determined that the cut-off for the decline of serum CA19-9 was 60.9% at 4 to 6 weeks after radiotherapy.The MST of ≥ 60.9% group and <60.9% group were 33.5 months(95% CI:0.24-66.76 months)and 9.0 months(95% CI:6.92-11.08 months)respectively (χ2=13.80, P<0.05). The corresponding mPFS were 11.0 months(95% CI:3.44-18.56 months)and 5.0 months(95% CI:3.91-6.09 months)respectively (χ2=8.71, P<0.05). Conclusions Patients with the baseline serum CA19-9 <1 109 U/ml had a better outcome after hypofraction tomotherapy combined with chemotherapy. The decline of serum CA19-9 at 4-6 weeks after radiotherapy can serve as a prompt and effective predictor of the outcome and the progression of patients. The decline of serum CA19-9 ≥ 60.9% in patients with pancreatic cancer is associated with a low possibility of disease progression in half a year, whose overall survival is better. |
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