| Objectives:Analysing pre-operation serum ferric iron,CA199,CA125,CA153,CEA level of distal cholangiocacinoma patients,to evaluate pre-operation serum ferric iron,CA199,CA125,CAI 53,CEA level value for distal cholangiocaecinoma patients diagnosis and differential diagnosis.Methods:Retrospective analysis was performed on 81 patients who underwent surgical resection in our hospital and were pathologically diagnosed with distal common bile duct adenocarcinoma from January 2014 to December 2020,and 51 patients who underwent physical examination in the physical examination center of our hospital during the same period.According to the clinical diagnosis,81 patients with distal choledochal adenocarcinoma were included in the distal choledochal carcinoma group,and 51 physical examination subjects were included in the healthy group.The serum iron ion titers and serum ferritin,CA19-9,CA125,CA15-3 and CEA titers and SFSIR of the two groups were analyzed statistically,and the diagnostic efficacy of the above indexes for distal choledochal adenocarcinoma was further evaluated.In addition,36 patients who received surgical treatment in our hospital and were pathologically diagnosed with ductal adenocarcinoma of the head of pancreas and 20 patients with sclerosing cholangitis treated in our hospital during the same period were collected,and these patients were included in the pancreatic head cancer group and the sclerosing cholangitis group according to disease types,respectively.The serum iron titers,serum ferritin,CA19-9,CA125,CA15-3 and CEA titers and SFSIR of the distal common bile duct carcinoma group and the above two groups were analyzed and compared pair by pair pairs,and the value of the above indexes for the differential diagnosis of distal common bile duct carcinoma was evaluated.Results:1.There were statistically significant differences in serum ferritin and serum ferritin/serum iron levels betweren the healthy group and the distal common bile duct carcinoma group(P<0.05).The sensitivity of serum ferritin level and serum ferritin/serum iron level for the diagnosis of distal common bile duct adenocarcinoma were 88.9%and 92.6%,the specificity was 94.1%and 90.2%,and the accuracy was 90.9%and 90.2%,respectively.The cut-off point values were 327.50umol/L and 13.42 umol/L/ng/mL(P<0.05).2.There was statistically significant difference in serum CA19-9 titer between the healthy group and the distal common bile duct carcinoma group(P<0.05).The sensitivity,specificity,cut-off value and accuracy of serum CA19-9 for the diagnosis of distal common bile duct adenoma were 84.0%,56.8%,26.7U/mL and 89.4%(P<0.05).3.After SF combined with CA19-9,the diagnostic sensitivity,specificity and AUC of distal common bile duct adenocarcinoma were 92.5%,98.0%,and 97.5%(AUC>60%)(P<0.05).The sensitivity,specificity and AUC of SFSIR combined with CA19-9 for the diagnosis of distal common bile duct adenocarcinoma were 93.8%,94.1%and 97.3%(AUC>60%)(P<0.05).SF,SFSIR and CA19-9 combined with each other in the diagnosis of distal common bile duct adenocarcinoma had a sensitivity of 92.5%,a specificity of 96.1%,and an AUC of 95.4%(AUC>60%)(P<0.05).4.There were significant statistical differences between SF and SFSIR in distal common bile duct adenocarcinoma and ductal pancreatic head adenocarcinoma,and between distal common bile duct adenocarcinoma and sclerosing cholangitis(P<0.05).The sensitivity,specificity and accuracy of SF in the differential diagnosis of distal choledochal adenocarcinoma and ductal carcinoma of the pancreatic head were 49.4%and 82.7%,91.7%and 65.0%,and 64.1%and 84.2%,respectively.The cut-off point values were 595.50umol/L and 372.88umol/L(P<0.05).SFSIR for the differential diagnosis of distal choledochal adenocarcinoma,pancreatic ductal adenocarcinoma and sclerosis cholangitis were 39.5%,82.7%,80.6%,80.0%,and the cut-off point values were 40.37,21.51(umol/L)/(ng/mL),respectively.The accuracy was 52.1%and 80.2%(P<0.05),respectively.5.There were no significant differences in serum titers of CA125,CA19-9,CA15-3 and CEA in distal choledochal adenocarcinoma,ductal adenocarcinoma of the head of pancreas and sclerosing cholangitis(P>0.05).6.The AUC of SF combined with SFSIR in distal choledochal adenocarcinoma,pancreatic ductal adenocarcinoma and sclerosing cholangitis were 73.7%and 85.0%(AUC>60%),respectively,the sensitivity were 43.2%and 79.0%,and the specificity were 97.2 and 80.0%,respectively(P<0.05).CoDclusions:1.Serum ferritin,serum ferritin/serum iron ion,and serum CA19-9 are of high value in the diagnosis of distal common bile duct adenocarcinoma.When the serum ferritin titer was higher than 327.50ng/mL and/or the serum ferritin/serum iron ion level was higher than 13.42 ng/mL(umol/L)and/or the serum CA19-9 titer was higher than 26.70U/mL,The accuracy of diagnosis of distal choledochal adenocarcinoma was 90.9%,90.2%and 89.4%,respectively.2.Serum ferritin and ferritin/ferric ion are of high value in the differential diagnosis of distal choledochal adenocarcinoma from ductal carcinoma of the head of pancreas and sclerosclerosis cholangitis.When the serum ferritin titer was higher than 595.50ng/mL and/or the serum ferritin/serum iron ion level was higher than 40.37 ng/(umol/L),the differential accuracy of distal common bile duct adenocarcinoma and ductal adenocarcinoma of the head of pancreas were 64.1%and 52.1%,respectively.When the serum ferritin titer was higher than 372.88ng/mL and/or the serum ferritin/serum iron ion level was greater than 21.51 ng/(umol/L),the differential accuracy of distal choledochal adenocarcinoma and sclosing cholangitis was 80.2%and 76.3%,respectively.3.Serum CA19-9 combined with SF,SFSIR and CA19-9,SF and SFSIR respectively has higher diagnostic value than any single index of SF,SFSIR and CA19-9 for distal common bile duct adenocellular carcinoma.SF combined with SFSIR has a higher value in the differential diagnosis of distal choledochal adenocarcinoma than either SF or SFSIR single index. |
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