Postoperative CA19-9 Change Is a Useful Predictor of Intrahepatic Cholangiocarcinoma Survival following Liver Resection.

Tae Yoo,Sung-Sik Han,Woo Jin Lee,Seong Hoon Kim,Seung Duk Lee,Tae Hyun Kim,Sang Myung Woo,Eun Kyung Hong,Sang-Jae Park,Young-Kyu Kim

doi:10.1155/2015/298985

Abstract

Background. To investigate the clinical significance of the perioperative CA19-9 change for predicting survival in intrahepatic cholangiocarcinoma (ICC) patients treated with surgical resection. Methods. We retrospectively reviewed the data from 74 ICC patients treated with surgical resection between April 2001 and July 2010. Perioperative CA19-9 (preoperative level, postoperative lowest level, and level at recurrence) levels were analyzed for patient distribution and survival. Results. Before surgery, there were 45 patients who had high preoperative CA19-9 levels (>37 U/mL) and 29 who had normal levels (≤37 U/mL). Of 45 patients with high CA19-9 levels, 34 had normalized CA19-9 levels after resection and 11 had persistently high levels. Of 34 patients with normalized CA19-9 levels, 18 showed recurrence. Of 29 patients with normal preoperative levels, 15 showed recurrence. Multivariate analysis presented that old age (hazard ratio [HR] = 3.881, p < 0.01), persistently high postoperative CA19-9 level (HR = 4.41, p < 0.001), perineural invasion (HR = 3.073, p = 0.01), narrow resection margin (HR = 3.152, p = 0.05), and lymph node metastasis (HR = 3.427, p = 0.02) were significant independent risk factors for survival. Conclusions. Patients who have normalized CA19-9 levels postoperatively have longer survival outcomes. Therefore, normalized postoperative CA19-9 may be a useful clinical marker for ICC survival.

Highlights

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic cancer besides hepatocellular carcinoma but remains an uncommon and enigmatic disease [1]
Patients with preopCA19-9 ≤37 U/mL had a higher positivity for HBsAg (p = 0.02) and had a tendency toward smaller tumors, less lymphatic invasion, less lymph node metastases, longer resection margins, and earlier Tstages, statistically not significant (Table 1)
It has been documented that preopCA19-9 levels are useful for the diagnosis of intrahepatic cholangiocarcinoma (ICC) patients associated with primary sclerosing cholangitis and that elevated Carbohydrate antigen 19-9 (CA19-9) levels are related to tumor burden

Summary

Introduction

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic cancer besides hepatocellular carcinoma but remains an uncommon and enigmatic disease [1]. Many studies have been undertaken to investigate potential prognostic factors and their contribution to survival in patients who benefit from surgical resection. Previous studies have reported that CA19-9 expression is prevalent in ICC1 and high preoperative CA19-9 level is independent dismal prognostic factor [1]. To investigate the clinical significance of the perioperative CA19-9 change for predicting survival in intrahepatic cholangiocarcinoma (ICC) patients treated with surgical resection. Multivariate analysis presented that old age (hazard ratio [HR] = 3.881, p < 0.01), persistently high postoperative CA19-9 level (HR = 4.41, p < 0.001), perineural invasion (HR = 3.073, p = 0.01), narrow resection margin (HR = 3.152, p = 0.05), and lymph node metastasis (HR = 3.427, p = 0.02) were significant independent risk factors for survival. Normalized postoperative CA19-9 may be a useful clinical marker for ICC survival

Methods

Results

Discussion

Conclusion