关键词:

胆囊癌, CA19-9, NLR, 根治手术, 疾病转归, 预测价值

Abstract:

Objective　To explore the clinical significance of carbohydrate antigen 19-9 (CA19-9) and neutrophil to lymphocyte ratio (NLR) in the prognosis of patients with gallbladder cancer after radical surgery. Methods　Seventy-two patients with gallbladder cancer who underwent radical resection in Linyi Central Hospital from January 2015 to December 2021 and completed one-year follow-up were selected as a gallbladder cancer group, including 39 cases and 33 cases who were (63.19±3.85) years old. According to the 1:1 matching principle, another 72 patients with gallbladder polyps during the same period were selected as a control group, including 37 males and 35 females who were (62.54±3.52) years old. The serum levels of CA19-9 and NLR's were compared between the two groups at admission. The levels of CA19-9 and NLR's were compared between the patients with different outcomes at admission and 1 week after the surgery and between the patients with different pathological parameters. Spearman analysis was used to investigate the correlations of CA19-9 and NLR with pathological parameters and disease outcomes at admission. The receiver operating characteristic curve (ROC) was used to investigate the predictive values of the combined detection at admission and 1 week after surgery for poor outcomes in the patients with gallbladder cancer. Results　The serum level of CA19-9 and NLR at admission in the gallbladder cancer group were higher than those in the control group [(237.14±38.41) U/ml vs. (31.87±6.43) U/ml and (4.02±1.25) vs. (1.84±0.43); both P<0.05]. The serum levels of CA19-9 and NLR's at admission and 1 week after the surgery in the patients with poor prognosis were higher than those in the patients with good prognosis [(261.71±25.33) U/ml vs. (218.56±24.52) U/ml, (4.73±1.02) vs. (3.48±0.75), (181.64±28.58) U/ml vs. (85.43±12.19) U/ml, and (3.37±0.48) vs. (2.24±0.53); all P<0.05]. Comparison of serum level of CA19-9 and NLR between the patients with different pathological parameters: those in the moderately and highly differentiated patients were lower than those in the poorly differentiated patients [(208.41±22.83) U/ml vs. (294.60±23.18) U/ml and (3.14±0.47) vs. (5.78±0.69)]; those in the stage Ⅰ-Ⅱ patients were lower than those in the stage Ⅲ-Ⅳpatients [(188.43±25.63) U/ml vs. (276.11±23.08) U/ml and (2.95±0.57) vs. (4.88±0.64)]; those in the patients with no lymph node metastasis were lower than those in the patients with lymph node metastasis [(206.93±24.25) U/ml vs. (287.49±16.64) U/ml and (3.38±0.49) vs. (5.09±0.73)]; both indicators were negatively correlated with tissue differentiation (r=-0.698 and -0.533), and positively correlated with clinical stage (r=0.742 and 0.659), lymph node metastasis (r=0.701 and 0.634), and disease outcome (r=0.588 and 0.719) (all P<0.05). The areas under the curves (AUC) of serum CA19-9 and NLR for predicting poor prognosis in the patients at admission and 1 week after the surgery were 0.776 (95%CI 0.718-0.839) and 0.834 (95%CI 0.768-0.906), respectively. The optimal predictive sensitivities were 87.10% and 93.55%, respectively; the optimal predictive specificities were 68.29% and 73.17%, respectively. Conclusion　CA19-9 and NLR are upregulated in the serum of patients with poor prognosis after radical cholecystectomy for gallbladder cancer. These two indicators are correlated with clinical pathological parameters and disease outcomes. The combined detection has certain predictive value for prognosis and can be used as auxiliary indicators for clinical prediction of the patients' postoperative prognosis.

Key words:

Gallbladder cancer, Carbohydrate antigen 19-9, Neutrophil to lymphocyte ratio, Radical surgery, Disease outcomes, Predictive value