血漿中の術前可溶性AXLは膵管腺癌切除の無益性を予測する

Surgical resection combined with chemotherapy offers the best chance of survival in pancreatic ductal adenocarcinoma (PDAC), but many will experience recurrence and early mortality. We examined soluble AXL (sAXL), a blood protein, for its ability to predict 6-month mortality after resection and compared it to CA19-9. Fifty-four patients with PDAC who underwent tumour resection were analyzed to assess biomarker performance and identify optimal cut-off levels. The cut-off for sAXL was 40.26 ng/mL (sensitivity 0.729; specificity 0.643), while it 253.3 U/mL for CA19-9 (sensitivity 0.591; specificity 0.621). Patients with sAXL > 40.26 ng/mL had a non-significant trend toward worse survival (log-rank p = 0.088). Univariate Cox regression revealed that high tumour grade (3 + 4) and positive resection margin significantly predicted early mortality. Multivariate Cox regression showed that sAXL > 40.26 ng/mL remained associated with 6-month mortality (hazard ratio 2.42, bootstrap 95% CI 1.15-5.65, p = 0.020), independent of high tumour grade (hazard ratio 4.02, bootstrap 95% CI 1.68-13.2, p = 0.002). These findings suggest that a preoperative blood test (sAXL) has utility for predicting futile surgery beyond the current standard, CA19-9, and can be incorporated into larger models to assist in risk stratification and follow-up planning.