Abstract
BackgroundTo investigate the predictive values of preoperative and postoperative serum CA19-9 levels on survival and other prognostic factors including early recurrence in patients with resectable hilar cholangiocarcinoma.ResultsIn univariate analysis, increased preoperative and postoperative CA19-9 levels in the light of different cut-off points (37, 100, 150, 200, 400, 1000 U/ml) were significantly associated with poor survival outcomes, of which the cut-off point of 150 U/ml showed the strongest predictive value (both P < 0.001). Preoperative to postoperative increase in CA19-9 level was also correlated with poor survival outcome (P < 0.001). In multivariate analysis, preoperative CA19-9 level > 150 U/ml was significantly associated with lymph node metastasis (OR = 3.471, 95% CI 1.216–9.905; P = 0.020) and early recurrence (OR = 8.280, 95% CI 2.391–28.674; P = 0.001). Meanwhile, postoperative CA19-9 level > 150 U/ml was also correlated with early recurrence (OR = 4.006, 95% CI 1.107–14.459; P = 0.034).Materials and MethodsNinety-eight patients who had undergone curative surgery for hilar cholangiocarcinoma between 1995 and 2014 in our institution were selected for the study. The correlations of preoperative and postoperative serum CA19-9 levels on the basis of different cut-off points with survival and various tumor factors were retrospectively analyzed with univariate and multivariate methods.ConclusionsIn patients with resectable hilar cholangiocarcinoma, serum CA19-9 predict survival and early recurrence. Patients with increased preoperative and postoperative CA19-9 levels have poor survival outcomes and higher tendency of early recurrence.
Highlights
Hilar cholangiocarcinoma (HCCA) is featured by advanced tumor biology, low surgical resectability, high recurrence and poor survival outcome [1,2,3,4]
Preoperative to postoperative increase in carbohydrate antigen 19-9 (CA19-9) level was correlated with poor survival outcome (P < 0.001)
Preoperative CA19-9 level > 150 U/ml was significantly associated with lymph node metastasis (OR = 3.471, 95% CI 1.216–9.905; P = 0.020) and early recurrence (OR = 8.280, 95% CI 2.391–28.674; P = 0.001)
Summary
Hilar cholangiocarcinoma (HCCA) is featured by advanced tumor biology, low surgical resectability, high recurrence and poor survival outcome [1,2,3,4]. Serum carbohydrate antigen 19-9 (CA19-9) has been extensively applied in conventional clinical practices for diagnosis, treatment options, prognosis and therapeutic response detection in HCCA [12,13,14]. The prognostic effect of CA19-9 levels on survival remains disputable: several investigators have reported increased preoperative CA19-9 levels predict poor survival outcome [15,16,17], while others noted that preoperative www.impactjournals.com/oncotarget. To investigate the predictive values of preoperative and postoperative serum CA19-9 levels on survival and other prognostic factors including early recurrence in patients with resectable hilar cholangiocarcinoma
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