Abstract
Cholangiocarcinoma (CCA) represents a rare form of primary liver cancer with increasing incidence but dismal prognosis. Surgical treatment has remained the only potentially curative treatment option, but it remains unclear which patients benefit most from liver surgery, highlighting the need for new preoperative stratification strategies. In clinical routine, CA19-9 represents the most widely used tumor marker in CCA patients. However, data on the prognostic value of CA19-9 in CCA patients are limited and often inconclusive, mostly due to small cohort sizes. Here, we investigated the prognostic value of CA19-9 in comparison with other standard laboratory markers in a large cohort of CCA patients that underwent tumor resection. Of note, while CA19-9 and CEA were able to discriminate between CCA and healthy controls, CEA showed a higher accuracy for the differentiation between CCA and patients with primary sclerosing cholangitis (PSC) compared to CA19-9. Furthermore, patients with elevated levels of C-reactive protein (CRP), CA19-9 or CEA showed a significantly impaired survival in Kaplan-Meier curve analysis, but surprisingly, only CEA but not CA19-9 represented an independent predictor of survival in multivariate Cox-regression analysis. Our data suggest that CEA might help to identify CCA patients with an unfavourable prognosis after tumor resection.
Highlights
Cholangiocarcinoma (CCA) represents the second most common primary hepatic malignancy, it can be considered a rare type of gastrointestinal cancer comprising less than 1% of all human malignancies[1,2]
Beyond the standard diagnostic criteria that define if a patient is resectable or not[9,10,11,12], it is still not fully clear which patients benefit from extensive liver surgery in terms of post-operative survival and which patients continue to have a poor prognosis even after tumor resection
Serum levels of CA19-9 are elevated in patients with non-malignant biliary diseases such as primary sclerosing cholangitis or biliary obstruction due to choledocholithiasis[20,21], implying that CA19-9 might not be the ideal tool for surveillance of patients with benign biliary disease
Summary
Cholangiocarcinoma (CCA) represents the second most common primary hepatic malignancy, it can be considered a rare type of gastrointestinal cancer comprising less than 1% of all human malignancies[1,2]. CA19-9 has been suggested as a prognostic marker for CCA patients undergoing tumor resection[17,18] and patients receiving chemotherapy[19]. Given the small sample size of most studies in CCA patients[15,27,28,29], the diagnostic and prognostic values of these respective markers in the clinical setting of surgical resection have remained inconclusive. We aimed to evaluate the diagnostic and prognostic capabilities of CA19-9, CEA, CRP and other routinely measured laboratory parameters in a large cohort of CCA patients undergoing tumor resection at our tertiary referral centre between 2010 and 2016 in comparison to healthy control samples and patients with primary sclerosing cholangitis
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