Abstract
BackgroundAlthough carbohydrate antigen 19-9 (CA19-9) is an established prognostic marker for intrahepatic cholangiocarcinoma (ICC) patients, the significance of elevated preoperative CA19-9 that normalized after resection remains unknown. This study aimed to investigate whether elevated preoperative CA19-9 that normalized after curative resection had an impact on prognosis among patients with ICC.MethodsPatients who underwent curative resection for stage I to III ICC between 2009 and 2018 were identified. Patients were categorized into three cohorts: normal preoperative CA19-9, elevated preoperative CA19-9 but normalized postoperative CA19-9, and persistently elevated postoperative CA19-9. Overall survival (OS), recurrence-free survival (RFS), and hazard function curves over time were analyzed.ResultsA total of 511 patients (247 [48.3%] male; median age, 58 years) were included. Patients with elevated preoperative CA19-9 (n = 378) were associated with worse RFS and OS than those with normal preoperative CA19-9 (n = 152) (both p < 0.001). Patients with persistently elevated postoperative CA19-9 (n = 254) were correlated with lower RFS and OS than the combined cohorts with normal postoperative CA19-9 (n = 257) (both p < 0.001). The hazard function curves revealed that the risk of recurrence and mortality peaked earlier and higher in the elevated postoperative CA19-9 group than the other 2 groups. Multivariate analyses identified persistently elevated, rather than normalized, postoperative CA19-9 as an independent risk factor for shorter RFS and OS in ICC.ConclusionsElevated preoperative serum CA19-9 that normalizes after curative resection is not an indicator of poor prognosis in ICC. Patients with persistently elevated postoperative CA19-9 are at increased risk of recurrence and death.
Highlights
Intrahepatic cholangiocarcinoma (ICC) is the second most common form of primary liver cancer which accounts for 10%–15% of cases [1]
Preoperative carbohydrate antigen 19-9 (CA19-9) was determined by the value closest to the time of surgical procedure, while postoperative CA19-9 was defined as the last serum CA19-9 value closest to the time of 3 months after hepatectomy and before any other adjuvant treatments
Of the 378 patients with elevated preoperative CA19-9, postoperative CA19-9 was normalized in 105 patients and elevated in 254 patients (Figure 1)
Summary
Intrahepatic cholangiocarcinoma (ICC) is the second most common form of primary liver cancer which accounts for 10%–15% of cases [1]. Surgical resection remains the cornerstone with a radical clearance purpose for the curative therapy of ICC. Only approximately 20% patients are able to undergo hepatectomy and 5-year overall survival ranges from 25% to 40% after curative resection [2, 3]. Half of the patients experience early relapse within 2 years after surgery [4]. Considering that prognoses following surgery vary considerably, surgical resection alone may be insufficient for a subset of patients [5]. Carbohydrate antigen 19-9 (CA19-9) is an established prognostic marker for intrahepatic cholangiocarcinoma (ICC) patients, the significance of elevated preoperative CA19-9 that normalized after resection remains unknown. This study aimed to investigate whether elevated preoperative CA19-9 that normalized after curative resection had an impact on prognosis among patients with ICC
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