医学
接收机工作特性
CA19-9号
围手术期
胰腺癌
生物标志物
切断
内科学
尤登J统计
曲线下面积
胃肠病学
试验预测值
肿瘤标志物
外科
癌症
生物化学
化学
物理
量子力学
作者
A. Floortje van Oosten,Vincent P. Groot,Galina Dorland,Richard A. Burkhart,Christopher L. Wolfgang,Hjalmar C. van Santvoort,Jin He,I. Quintus Molenaar,Lois A. Daamen
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2023-07-03
被引量:5
标识
DOI:10.1097/sla.0000000000005977
摘要
Background: Carbohydrate antigen (CA) 19-9 is an established perioperative prognostic biomarker for pancreatic ductal adenocarcinoma (PDAC). However, it is unclear how CA19-9 monitoring should be used during postoperative surveillance to detect recurrence and to guide the initiation of recurrence-focused therapy. Objective: This study aimed to elucidate the value of CA19-9 as a diagnostic biomarker for disease recurrence in patients who underwent PDAC resection. Methods: Serum CA19-9 levels at diagnosis, after surgery, and during postoperative follow-up were analyzed in patients who underwent PDAC resection. All patients with at least two postoperative follow-up CA19-9 measurements prior to recurrence were included. Patients deemed to be non-secretors of CA19-9 were excluded. The relative increase in postoperative CA19-9 was calculated for each patient by dividing the maximum postoperative CA19-9 value by the first postoperative value. Receiver operating characteristic (ROC) analysis was performed to identify the optimal threshold for the relative increase in CA19-9 levels to identify recurrence in the training set using Youden’s index. The performance of this cutoff was validated in a test set by calculating the area under the curve (AUC) and was compared to the performance of the optimal cutoff for postoperative CA19-9 measurements as a continuous value. In addition, sensitivity, specificity, and predictive values were assessed. Results: In total, 271 patients were included, of whom 208 (77%) developed recurrence. ROC analysis demonstrated that a relative increase in postoperative serum CA19-9 of 2.6x was predictive of recurrence, with 58% sensitivity, 83% specificity, 95% positive predictive value, and 28% negative predictive value. The AUC for a 2.6x relative increase in CA19-9 level was 0.719 in the training set and 0.663 in the test set. The AUC of postoperative CA19-9 as a continuous value (optimal threshold, 52) was 0.671 in the training set. In the training set, the detection of a 2.6-fold increase in CA19-9 preceded the detection of recurrence by a mean difference of 7 months ( P <0.001) and in the test set by 10 months ( P <0.001). Conclusion: A relative increase in postoperative serum CA19-9 level of 2.6-fold is a stronger predictive marker for recurrence than a continuous CA19-9 cutoff. A relative CA19-9 increase can precede the detection of recurrence on imaging for up to 7–10 months. Therefore, CA19-9 dynamics can be used as a biomarker to guide the initiation of recurrence-focused treatment.
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