medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-228medsovet-10336Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHСА19-9 как прогностический фактор в лечении резектабельного и погранично резектабельного рака поджелудочной железыCA19-9 as a prognostic factor in the treatment of resectable and borderline resectable pancreatic adenocarcinomahttps://orcid.org/0000-0003-4691-7490СеменовН. Н.SemenovN. N.

Семенов Николай Николаевич, д.м.н., ведущий научный сотрудник отделения химиотерапии №1

111123, Москва, шоссе Энтузиастов, д. 86, стр. 6

Nikolay N. Semenov, Dr. Sci. (Med.), Senior Researcher, Chemotherapy Department No. 1

86, Entuziastov Shosse, Moscow, 111123

niksemenov1969@yandex.ruhttps://orcid.org/0000-0002-3177-1495ЗарьяновД. А.ZaryanovD. A.

Зарьянов Дмитрий Альбертович, врач-онколог химиотерапевтического отделения №1 

111123, Москва, шоссе Энтузиастов, д. 86, стр. 6

Dmitry A. Zaryanov, Oncologist, Chemotherapy Department No. 1

86, Entuziastov Shosse, Moscow, 111123

dmitry.zaryanov@yandex.ruhttps://orcid.org/0000-0002-0340-7119ФеоктистоваП. С.FeoktistovaP. S.

Феоктистова Полина Сергеевна, к.м.н., врач-онколог, заведующая химиотерапевтическим отделением №1

111123, Москва, шоссе Энтузиастов, д. 86, стр. 6

Polina S. Feoktistova, Cand. Sci. (Med.), Oncologist, Head of Chemotherapy Department No. 1

86, Entuziastov Shosse, Moscow, 111123

 

paolaf@mail.ruМосковский клинический научный центр имени А.С. ЛогиноваРоссияLoginov Moscow Clinical Scientific CenterRussian Federation202607092026010101106Copyright © Семенов Н.Н., Зарьянов Д.А., Феоктистова П.С., 20262026Семенов Н.Н., Зарьянов Д.А., Феоктистова П.С.Semenov N.N., Zaryanov D.A., Feoktistova P.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10336Введение

Введение. Онкомаркер СА19-9 используется в диагностике и лечении протоковой аденокарциномы поджелудочной железы (ПАПЖ). Его уровень коррелирует с опухолевой нагрузкой и риском наличия микрометастазов. В последние годы активно изучается возможность использования исходного уровня СА19-9 для планирования тактики лечения, включая выделение биологически погранично резектабельных ПАПЖ (уровень СА19-9 ≥ 500 Ед/мл) и определение показаний к неоадъювантной химиотерапии даже у анатомически резектабельных опухолей.

Цель

Цель. Оценить взаимосвязь между исходным уровнем СА19-9 у пациентов с резектабельной и погранично резектабельной ПАПЖ и показателями общей (ОВ) и бессобытийной (БСВ) выживаемости, определить группы пациентов, получающих наибольший выигрыш от проведения неоадъювантной химиотерапии.

Материалы и методы

Материалы и методы. Проведен ретроспективный анализ 150 пациентов, лечившихся по поводу резектабельной и погранично резектабельной ПАПЖ. У всех пациентов до начала лечения (при отсутствии механической желтухи) был определен уровень СА19-9. Все пациенты получали химиотерапию в режиме FOLFIRINOX и его модификациях.

Результаты

Результаты. Пациенты разделены на три группы в зависимости от уровня СА19-9: группа 1 (0–100 ед/мл), группа 2 (>100–500 Ед/мл), группа 3 (>500 Ед/мл). Медиана ОВ составила 47,5 мес. для группы 1 (0–100), 29,0 мес. для группы 2 (>100–500, p = 0,037) и 13,5 мес. для группы 3 (>500, p < 0,001). Медиана БСВ в группе >500 Ед/мл была 13,2 мес. против 18,5 мес. в группе 0–500 (p = 0,006). Пороговый анализ подтвердил ухудшение прогноза при уровне СА19-9 > 100 Ед/мл (ОВ 20,3 мес. vs 47,5 мес.; p < 0,001) и > 500 Ед/мл (ОВ 13,5 мес. vs 35,5 мес.; p < 0,001).

Выводы

Выводы. Исходный уровень СА19-9 является независимым прогностическим фактором у пациентов с резектабельной и погранично резектабельной ПАПЖ. Уровень >500 Ед/мл ассоциирован с неблагоприятным прогнозом. Пациенты с повышенным уровнем маркера получают наибольшую пользу от неоадъювантной химиотерапии, что обосновывает включение СА19-9 в алгоритмы принятия решений для персонализации лечения.

Introduction

Introduction. The tumor marker CA19-9 is used in the diagnosis and treatment of pancreatic ductal adenocarcinoma (PDAC). Its level correlates with tumor burden and the risk of micrometastases. In recent years, the possibility of using baseline CA19-9 levels to guide treatment strategy has been actively investigated, including the identification of biologically borderline resectable PDAC (CA19-9 ≥ 500 U/mL) and the determination of indications for neoadjuvant chemotherapy even in anatomically resectable tumors. Aim. To evaluate the relationship between baseline CA19-9 levels in patients with resectable and borderline resectable PDAC and overall survival (OS) and event-free survival (EFS), and to identify patient groups that derive the greatest benefit from neoadjuvant chemotherapy.

Materials and methods

Materials and methods. A retrospective analysis of 150 patients treated for resectable and borderline resectable PDAC was performed. In all patients, CA19-9 levels were determined before treatment (in the absence of obstructive jaundice). All patients received chemotherapy with the FOLFIRINOX regimen or its modifications.

Results

Results. Patients were divided into three groups according to CA19-9 levels: group 1 (0–100 U/mL), group 2 (>100–500 U/mL), and group 3 (>500 U/mL). Median OS was 47.5 months for group 1 (0–100), 29.0 months for group 2 (>100–500, p = 0.037), and 13.5 months for group 3 (>500, p < 0.001). Median EFS in the > 500 U/mL group was 13.2 months vs 18.5 months in the 0–500 group (p = 0.006). Threshold analysis confirmed a worse prognosis with CA19-9 levels > 100 U/mL (OS 20.3 months vs 47.5 months; p < 0.001) and >500 U/mL (OS 13.5 months vs 35.5 months; p < 0.001).

Conclusions

Conclusions. Baseline CA19-9 level is an independent prognostic factor in patients with resectable and borderline resectable PDAC. A level > 500 U/mL is associated with a poor prognosis. Patients with elevated marker levels derive the greatest benefit from neoadjuvant chemotherapy, supporting the inclusion of CA19-9 in decision-making algorithms for treatment personalization.

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The authors declare that there are no conflicts of interest present.