An elevated CA 19-9 is associated with invasive cancer and worse survival in IPMN
Current guidelines for IPMN include an elevated serum carbohydrate antigen (CA) 19-9 among the worrisome features. However, the correlation of CA 19-9 with histological malignant features and survival is unclear. Serum CEA is also currently used for preoperative management of IPMN, although its meas...
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| Veröffentlicht in: | Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2020-06, Vol.20 (4), p.729-735 |
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| creator | Ciprani, D. Morales-Oyarvide, V. Qadan, M. Hank, T. Weniger, M. Harrison, J.M. Rodrigues, C. Horick, N.K. Mino-Kenudson, M. Ferrone, C.R. Warshaw, A.L. Lillemoe, K.D. Fernández-del Castillo, C. |
| description | Current guidelines for IPMN include an elevated serum carbohydrate antigen (CA) 19-9 among the worrisome features. However, the correlation of CA 19-9 with histological malignant features and survival is unclear. Serum CEA is also currently used for preoperative management of IPMN, although its measurement is not evidence-based. Accordingly, we aimed to assess the role of these tumor markers as predictors of malignancy in IPMN.
IPMN resected between 1998 and 2018 at Massachusetts General Hospital were analyzed. Clinical, pathological and survival data were collected and compared to preoperative levels of CA 19-9 and CEA. Receiver operating characteristic (ROC) and Cox regression analyses were performed considering cut-offs of 37 U/ml (CA 19-9) and 5 μg/l (CEA).
Analysis of 594 patients showed that preoperative CA 19-9 levels > 37 U/ml (n = 128) were associated with an increased likelihood of invasive carcinoma when compared to normal levels (45.3% vs. 18.0%, P 37 U/ml (17.2% vs 4.9%, P |
| doi_str_mv | 10.1016/j.pan.2020.04.002 |
| format | Article |
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IPMN resected between 1998 and 2018 at Massachusetts General Hospital were analyzed. Clinical, pathological and survival data were collected and compared to preoperative levels of CA 19-9 and CEA. Receiver operating characteristic (ROC) and Cox regression analyses were performed considering cut-offs of 37 U/ml (CA 19-9) and 5 μg/l (CEA).
Analysis of 594 patients showed that preoperative CA 19-9 levels > 37 U/ml (n = 128) were associated with an increased likelihood of invasive carcinoma when compared to normal levels (45.3% vs. 18.0%, P < 0.001), while there was no difference with respect to high-grade dysplasia (32.9% vs 31.9%, P = 0.88). The proportion of concurrent pancreatic cancer was higher in patients with CA 19-9 > 37 U/ml (17.2% vs 4.9%, P < 0.001). An elevated CA 19-9 was also associated with worse overall and disease-free survival (HR = 1.943, P = 0.007 and HR = 2.484, P < 0.001 respectively). CEA levels did not correlate with malignancy.
In patients with IPMN, serum CA19-9 > 37 U/ml is associated with invasive IPMN and concurrent pancreatic cancer as well as worse survival, but not with high-grade dysplasia. Serum CEA appears to have minimal utility in the management of these patients.</description><identifier>ISSN: 1424-3903</identifier><identifier>EISSN: 1424-3911</identifier><identifier>DOI: 10.1016/j.pan.2020.04.002</identifier><identifier>PMID: 32332003</identifier><language>eng</language><publisher>Switzerland: Elsevier B.V</publisher><subject>Accuracy ; Adenocarcinoma, Mucinous ; Adult ; Aged ; Aged, 80 and over ; Antigens ; Biomarkers, Tumor - blood ; CA 19-9 ; CA-19-9 Antigen - blood ; Cancer ; Carcinoembryonic antigen ; CEA ; Comorbidity ; Diabetes ; Dysplasia ; Female ; Humans ; Intraductal papillary mucinous neoplasm ; Invasiveness ; Male ; Malignancy ; Middle Aged ; Pancreatic cancer ; Pancreatic Intraductal Neoplasms - blood ; Pancreatic Intraductal Neoplasms - pathology ; Pancreatic Intraductal Neoplasms - therapy ; Pancreatic Neoplasms ; Pancreatic Neoplasms - blood ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - therapy ; Patients ; Regression analysis ; Sensitivity and Specificity ; Statistical analysis ; Survival ; Survival analysis ; Tumor markers ; Tumors</subject><ispartof>Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 2020-06, Vol.20 (4), p.729-735</ispartof><rights>2020 IAP and EPC</rights><rights>Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.</rights><rights>2020. IAP and EPC</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-96ea4b4a054f9200997ea85b4eb96235a421e11ebd2f1e048c2e8bb122db4c463</citedby><cites>FETCH-LOGICAL-c381t-96ea4b4a054f9200997ea85b4eb96235a421e11ebd2f1e048c2e8bb122db4c463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32332003$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ciprani, D.</creatorcontrib><creatorcontrib>Morales-Oyarvide, V.</creatorcontrib><creatorcontrib>Qadan, M.</creatorcontrib><creatorcontrib>Hank, T.</creatorcontrib><creatorcontrib>Weniger, M.</creatorcontrib><creatorcontrib>Harrison, J.M.</creatorcontrib><creatorcontrib>Rodrigues, C.</creatorcontrib><creatorcontrib>Horick, N.K.</creatorcontrib><creatorcontrib>Mino-Kenudson, M.</creatorcontrib><creatorcontrib>Ferrone, C.R.</creatorcontrib><creatorcontrib>Warshaw, A.L.</creatorcontrib><creatorcontrib>Lillemoe, K.D.</creatorcontrib><creatorcontrib>Fernández-del Castillo, C.</creatorcontrib><title>An elevated CA 19-9 is associated with invasive cancer and worse survival in IPMN</title><title>Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]</title><addtitle>Pancreatology</addtitle><description>Current guidelines for IPMN include an elevated serum carbohydrate antigen (CA) 19-9 among the worrisome features. However, the correlation of CA 19-9 with histological malignant features and survival is unclear. Serum CEA is also currently used for preoperative management of IPMN, although its measurement is not evidence-based. Accordingly, we aimed to assess the role of these tumor markers as predictors of malignancy in IPMN.
IPMN resected between 1998 and 2018 at Massachusetts General Hospital were analyzed. Clinical, pathological and survival data were collected and compared to preoperative levels of CA 19-9 and CEA. Receiver operating characteristic (ROC) and Cox regression analyses were performed considering cut-offs of 37 U/ml (CA 19-9) and 5 μg/l (CEA).
Analysis of 594 patients showed that preoperative CA 19-9 levels > 37 U/ml (n = 128) were associated with an increased likelihood of invasive carcinoma when compared to normal levels (45.3% vs. 18.0%, P < 0.001), while there was no difference with respect to high-grade dysplasia (32.9% vs 31.9%, P = 0.88). The proportion of concurrent pancreatic cancer was higher in patients with CA 19-9 > 37 U/ml (17.2% vs 4.9%, P < 0.001). An elevated CA 19-9 was also associated with worse overall and disease-free survival (HR = 1.943, P = 0.007 and HR = 2.484, P < 0.001 respectively). CEA levels did not correlate with malignancy.
In patients with IPMN, serum CA19-9 > 37 U/ml is associated with invasive IPMN and concurrent pancreatic cancer as well as worse survival, but not with high-grade dysplasia. Serum CEA appears to have minimal utility in the management of these patients.</description><subject>Accuracy</subject><subject>Adenocarcinoma, Mucinous</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antigens</subject><subject>Biomarkers, Tumor - blood</subject><subject>CA 19-9</subject><subject>CA-19-9 Antigen - blood</subject><subject>Cancer</subject><subject>Carcinoembryonic antigen</subject><subject>CEA</subject><subject>Comorbidity</subject><subject>Diabetes</subject><subject>Dysplasia</subject><subject>Female</subject><subject>Humans</subject><subject>Intraductal papillary mucinous neoplasm</subject><subject>Invasiveness</subject><subject>Male</subject><subject>Malignancy</subject><subject>Middle Aged</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Intraductal Neoplasms - blood</subject><subject>Pancreatic Intraductal Neoplasms - pathology</subject><subject>Pancreatic Intraductal Neoplasms - therapy</subject><subject>Pancreatic Neoplasms</subject><subject>Pancreatic Neoplasms - blood</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - therapy</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Sensitivity and Specificity</subject><subject>Statistical analysis</subject><subject>Survival</subject><subject>Survival analysis</subject><subject>Tumor markers</subject><subject>Tumors</subject><issn>1424-3903</issn><issn>1424-3911</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LAzEQhoMotn78AC8S8OJl10ySths8leJHoX6BnkM2O8WU7W5Ndlf896a29uDB0wwzz7wMDyFnwFJgMLxapCtTpZxxljKZMsb3SB8kl4lQAPu7nokeOQphEQEOoA5JT3AhOGOiT17GFcUSO9NgQSdjCipR1AVqQqit-5l-uuaduqozwXVIraksemqquKh9QBpa37nOlBGh0-eHxxNyMDdlwNNtPSZvtzevk_tk9nQ3nYxniRUZNIkaopG5NGwg5yr-otQITTbIJeZqyMXASA4IgHnB54BMZpZjlufAeZFLK4fimFxucle-_mgxNHrpgsWyNBXWbdBcKJkpBkJG9OIPuqhbX8XvNJcwGkVbCiIFG8r6OgSPc73ybmn8lwam1771Qkffeu1bM6mjznhzvk1u8yUWu4tfwRG43gAYVXQOvQ7WYVRYOI-20UXt_on_BkwHjR8</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Ciprani, D.</creator><creator>Morales-Oyarvide, V.</creator><creator>Qadan, M.</creator><creator>Hank, T.</creator><creator>Weniger, M.</creator><creator>Harrison, J.M.</creator><creator>Rodrigues, C.</creator><creator>Horick, N.K.</creator><creator>Mino-Kenudson, M.</creator><creator>Ferrone, C.R.</creator><creator>Warshaw, A.L.</creator><creator>Lillemoe, K.D.</creator><creator>Fernández-del Castillo, C.</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>202006</creationdate><title>An elevated CA 19-9 is associated with invasive cancer and worse survival in IPMN</title><author>Ciprani, D. ; Morales-Oyarvide, V. ; Qadan, M. ; Hank, T. ; Weniger, M. ; Harrison, J.M. ; Rodrigues, C. ; Horick, N.K. ; Mino-Kenudson, M. ; Ferrone, C.R. ; Warshaw, A.L. ; Lillemoe, K.D. ; Fernández-del Castillo, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-96ea4b4a054f9200997ea85b4eb96235a421e11ebd2f1e048c2e8bb122db4c463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Accuracy</topic><topic>Adenocarcinoma, Mucinous</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antigens</topic><topic>Biomarkers, Tumor - blood</topic><topic>CA 19-9</topic><topic>CA-19-9 Antigen - blood</topic><topic>Cancer</topic><topic>Carcinoembryonic antigen</topic><topic>CEA</topic><topic>Comorbidity</topic><topic>Diabetes</topic><topic>Dysplasia</topic><topic>Female</topic><topic>Humans</topic><topic>Intraductal papillary mucinous neoplasm</topic><topic>Invasiveness</topic><topic>Male</topic><topic>Malignancy</topic><topic>Middle Aged</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Intraductal Neoplasms - blood</topic><topic>Pancreatic Intraductal Neoplasms - pathology</topic><topic>Pancreatic Intraductal Neoplasms - therapy</topic><topic>Pancreatic Neoplasms</topic><topic>Pancreatic Neoplasms - blood</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - therapy</topic><topic>Patients</topic><topic>Regression analysis</topic><topic>Sensitivity and Specificity</topic><topic>Statistical analysis</topic><topic>Survival</topic><topic>Survival analysis</topic><topic>Tumor markers</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ciprani, D.</creatorcontrib><creatorcontrib>Morales-Oyarvide, V.</creatorcontrib><creatorcontrib>Qadan, M.</creatorcontrib><creatorcontrib>Hank, T.</creatorcontrib><creatorcontrib>Weniger, M.</creatorcontrib><creatorcontrib>Harrison, J.M.</creatorcontrib><creatorcontrib>Rodrigues, C.</creatorcontrib><creatorcontrib>Horick, N.K.</creatorcontrib><creatorcontrib>Mino-Kenudson, M.</creatorcontrib><creatorcontrib>Ferrone, C.R.</creatorcontrib><creatorcontrib>Warshaw, A.L.</creatorcontrib><creatorcontrib>Lillemoe, K.D.</creatorcontrib><creatorcontrib>Fernández-del Castillo, C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ciprani, D.</au><au>Morales-Oyarvide, V.</au><au>Qadan, M.</au><au>Hank, T.</au><au>Weniger, M.</au><au>Harrison, J.M.</au><au>Rodrigues, C.</au><au>Horick, N.K.</au><au>Mino-Kenudson, M.</au><au>Ferrone, C.R.</au><au>Warshaw, A.L.</au><au>Lillemoe, K.D.</au><au>Fernández-del Castillo, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An elevated CA 19-9 is associated with invasive cancer and worse survival in IPMN</atitle><jtitle>Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]</jtitle><addtitle>Pancreatology</addtitle><date>2020-06</date><risdate>2020</risdate><volume>20</volume><issue>4</issue><spage>729</spage><epage>735</epage><pages>729-735</pages><issn>1424-3903</issn><eissn>1424-3911</eissn><abstract>Current guidelines for IPMN include an elevated serum carbohydrate antigen (CA) 19-9 among the worrisome features. However, the correlation of CA 19-9 with histological malignant features and survival is unclear. Serum CEA is also currently used for preoperative management of IPMN, although its measurement is not evidence-based. Accordingly, we aimed to assess the role of these tumor markers as predictors of malignancy in IPMN.
IPMN resected between 1998 and 2018 at Massachusetts General Hospital were analyzed. Clinical, pathological and survival data were collected and compared to preoperative levels of CA 19-9 and CEA. Receiver operating characteristic (ROC) and Cox regression analyses were performed considering cut-offs of 37 U/ml (CA 19-9) and 5 μg/l (CEA).
Analysis of 594 patients showed that preoperative CA 19-9 levels > 37 U/ml (n = 128) were associated with an increased likelihood of invasive carcinoma when compared to normal levels (45.3% vs. 18.0%, P < 0.001), while there was no difference with respect to high-grade dysplasia (32.9% vs 31.9%, P = 0.88). The proportion of concurrent pancreatic cancer was higher in patients with CA 19-9 > 37 U/ml (17.2% vs 4.9%, P < 0.001). An elevated CA 19-9 was also associated with worse overall and disease-free survival (HR = 1.943, P = 0.007 and HR = 2.484, P < 0.001 respectively). CEA levels did not correlate with malignancy.
In patients with IPMN, serum CA19-9 > 37 U/ml is associated with invasive IPMN and concurrent pancreatic cancer as well as worse survival, but not with high-grade dysplasia. Serum CEA appears to have minimal utility in the management of these patients.</abstract><cop>Switzerland</cop><pub>Elsevier B.V</pub><pmid>32332003</pmid><doi>10.1016/j.pan.2020.04.002</doi><tpages>7</tpages></addata></record> |
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| ispartof | Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 2020-06, Vol.20 (4), p.729-735 |
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| subjects | Accuracy Adenocarcinoma, Mucinous Adult Aged Aged, 80 and over Antigens Biomarkers, Tumor - blood CA 19-9 CA-19-9 Antigen - blood Cancer Carcinoembryonic antigen CEA Comorbidity Diabetes Dysplasia Female Humans Intraductal papillary mucinous neoplasm Invasiveness Male Malignancy Middle Aged Pancreatic cancer Pancreatic Intraductal Neoplasms - blood Pancreatic Intraductal Neoplasms - pathology Pancreatic Intraductal Neoplasms - therapy Pancreatic Neoplasms Pancreatic Neoplasms - blood Pancreatic Neoplasms - pathology Pancreatic Neoplasms - therapy Patients Regression analysis Sensitivity and Specificity Statistical analysis Survival Survival analysis Tumor markers Tumors |
| title | An elevated CA 19-9 is associated with invasive cancer and worse survival in IPMN |
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