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Register a new userDecrease of CA 19-9 during chemotherapy predicts survival time in patients with advanced pancreatic cancer
دراسة العلاقة بين نقصان مستويات CA19-9 أثناء العلاج الكيميائي و تحسن معدل البقيا لدى مرضى أورام البنكرياس المتقدمة (خبرة مشفى تشرين الجامعي في اللاذقية بين عامي 2014-2015)
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Tishreen University ورقة بحثية
Publication date
2016
fields
Medicine
and research's language is
العربية
Created by
Shamra Editor
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أثبتت الدراسات وجود قيمة إنذارية للواسم الورمي CA19-9 بعد الجراحة لدى مرضى سرطانة البنكرياس القابلين للجراحة .الهدف من دراستنا هو معرفة فيما إذا كان لهذا الواسم نفس القيمة الإنذارية لدى مرضى سرطانة البنكرياس المتقدمة غير القابلة للجراحة و الذين خضعوا للعلاج الكيماوي . بين شهري أذار 2014 و كانون الأول 2015 ، خضع 36 مريض (متوسط العمر 57 سنة ، تراوحت الأعمار بين 38-80 سنة ، 9 إناث ،27 ذكور ) لديهم سرطانة بنكرياس غدية متقدمة موضعياً أو نقائلية مع مشعر karnofsky أكبر أو يساوي 60 للعلاج الكيماوي. فقط المرضى ذوي قيمة الواسم المرتفعة مع قيمة البيليروبين أقل من 2 ملغ/دل هم من أدخلوا في الدراسة. تم قياس البقيا اعتباراً من القيمة الأولى للواسم الورمي بعد العلاج و حتى الوفاة أو حتى أخر متابعة . تبين أن كانت معدلات البقيا الوسطية لدى المرضى الذين انخفض لديهم الواسم CA19-9 أكثر من 20% من القيمة القاعدية بعد 8 أسابيع من العلاج أفضل بفارق هام إحصائياً عن البقيا لدى بقية المرضى ( 6.98 مقابل 4.68 شهر ، P=0.007). في حين لم يشكل العمر و قيمة الواسم البدئية عوامل مستقلة في التأثير على البقيا ( P=0.987 ،P=0.878 على التوالي ). كانت البقيا أفضل عند الإناث منه عند الذكور بفارق هام إحصائياً ( 7.83 مقابل 5.75 شهر ، P=0.023 ).
Studies demonstrated a prognostic role for postoperative CA 19-9 in patients with resectable pancreatic carcinoma following surgery. Our study aimed to investigate whether CA 19-9 provided similar prognostic information in patients with advanced unresectable pancreatic cancer treated with chemotherapy and to determine whether such endpoints should therefore be reported in future randomized trials. Between Mars 2014 and December 2015, 36 patients ( median age 57 years, range 38-80 years, 9 females, 27 males ) with locally advanced or metastatic pancreatic adenocarcinoma and a baseline Karnofsky-index more than 60 were treated with chemotherapy . Only patients with a bilirubin of less than 2 mg/dL at the time the CA 19-9 was evaluated were included in the analysis to avoid the confounding effect of hyperbilirubinemia. Only patients with basal high CA19-9 were included in the analysis. Survival was measured from the date of first post CRT CA 19-9 level until death or last follow-up. Patients with a decrease of20 < % of the baseline CA19-9 level after 8 weeks of treatment (n=25) had a significantly better median survival than patients with a rise or a decrease < 20% (n-11) (6.98 vs4.68 months; p=0.007). Age and basal CA19-9 did not show significant or a trend for significant differences regarding survival by univariate analysis (P=0.987, p=0.878 respectively). Females had a significantly better median survival than males (7.83 vs 5.75 months, P=0.023).
Artificial intelligence review:
Research summary
تناولت الدراسة العلاقة بين نقصان مستويات الواسم الورمي CA19-9 أثناء العلاج الكيميائي وتحسن معدل البقيا لدى مرضى أورام البنكرياس المتقدمة غير القابلة للجراحة. شملت الدراسة 36 مريضًا (27 ذكور و9 إناث) بمتوسط عمر 57 سنة، وتمت متابعة المرضى بين مارس 2014 وديسمبر 2015. أظهرت النتائج أن المرضى الذين انخفضت لديهم مستويات CA19-9 بنسبة تزيد عن 20% بعد 8 أسابيع من العلاج الكيميائي حققوا معدلات بقيا أفضل بشكل ملحوظ مقارنة بالمرضى الآخرين. لم يكن للعمر أو قيمة الواسم البدئية تأثير مستقل على البقيا، بينما كانت البقيا أفضل عند الإناث مقارنة بالذكور. توصي الدراسة بمتابعة مستويات CA19-9 لدى جميع مرضى سرطان البنكرياس لتحديد الإنذار وتوجيه استراتيجيات العلاج.
Critical review
دراسة نقدية: تعتبر هذه الدراسة خطوة مهمة في فهم العلاقة بين مستويات الواسم الورمي CA19-9 وتحسن معدل البقيا لدى مرضى أورام البنكرياس المتقدمة. ومع ذلك، هناك بعض النقاط التي يمكن تحسينها. أولاً، حجم العينة صغير نسبياً، مما قد يؤثر على دقة النتائج. ثانياً، لم تتناول الدراسة بعض العوامل الأخرى التي قد تؤثر على البقيا مثل الدرجة النسيجية للورم ومرحلة الورم، والتي تم تناولها في دراسات أخرى. ثالثاً، لم يتم التطرق إلى تأثير أنواع مختلفة من العلاج الكيميائي على النتائج. من المفيد إجراء دراسات مستقبلية تشمل عدد أكبر من المرضى وتأخذ في الاعتبار هذه العوامل الإضافية.
Questions related to the research
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ما هو الهدف الرئيسي من الدراسة؟
الهدف الرئيسي هو دراسة العلاقة بين مستويات CA19-9 أثناء العلاج الكيميائي ومعدل البقيا لدى مرضى سرطان البنكرياس المتقدم غير القابل للجراحة.
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ما هي النتائج الرئيسية التي توصلت إليها الدراسة؟
النتائج الرئيسية هي أن المرضى الذين انخفضت لديهم مستويات CA19-9 بنسبة تزيد عن 20% بعد 8 أسابيع من العلاج الكيميائي حققوا معدلات بقيا أفضل بشكل ملحوظ.
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هل كان للعمر أو قيمة الواسم البدئية تأثير على معدل البقيا؟
لا، لم يكن للعمر أو قيمة الواسم البدئية تأثير مستقل على معدل البقيا وفقًا لنتائج الدراسة.
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ما هي التوصيات التي قدمتها الدراسة بناءً على النتائج؟
توصي الدراسة بمتابعة مستويات CA19-9 لدى جميع مرضى سرطان البنكرياس لتحديد الإنذار وتوجيه استراتيجيات العلاج، وإيقاف العلاج الكيميائي لدى المرضى الذين لم تتخفض لديهم قيمة الواسم.
References used
GONZALEZ, G, N; KRISHNAN, S; et al. Is CA19-9 Response Following Chemoradiation Therapy for Borderline Resectable Pancreatic Cancer an Early Surrogate for Eventual Survival Outcomes? .Volume 87, ASTRO's 55th Annual Metting , Elsevier, USA, October 2013, 312
YANG, G, Y;MALIK, N, K. Change in CA 19-9 levels after chemoradiotherapy predicts survival in patients with locally advanced unresectable pancreatic cancer.V4(4), J Gastrointest Oncol, California, 2013, 361-369
HALM, U; SCHUMANN. Decrease of CA 19-9 during chemotherapy with gemcitabine predicts survival time in patients with advanced pancreatic cancer. 82(4), British Journal of Cancer, London, 2000, 1013-1016
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