Prognostic impact of perioperative CA19-9 levels in patients with resected perihilar cholangiocarcinoma

Abstract

The clinical significance of perioperatibe level of carbohydrate antigen (CA) 19-9 in perihilar cholangiocarcinoma (PHCC) has not been well established. This study aimed to examine whether perioperative change of CA19-9 levels could predict prognosis of patients underwent surgery for PHCC. This study included 322 patients who underwent curative resection for PHCC. Patients were divided into 3 groups; normal preoperative normal CA19-9 group (CA19-9 ≤ 37 U/mL), normalization group (preoperative CA19-9 > 37 U/mL, postoperative CA19-9 ≤ 37 U/mL) and non-normalization group (both preoperative and postoperative CA19-9 > 37 U/mL). The association of clinicopathological factors (including perioperative serum CA19-9 levels) with overall survival (OS) was investigated. The non-normalization group (82 patients) showed significantly worse OS than normal CA19-9 group (114) and normalization group (126) (5-year OS, 16.9%, 29.4%, and 34.4%; both p ≤ 0.001). Cut-off points of preoperative 300 U/mL (p = 0.001) and postoperative 37 U/mL (p < 0.001) showed highest significant prognostic value. In the non-normalization group, patients who underwent R1 resection showed significant worse OS than those who underwent R0 resection (median OS, 10.2 vs. 15.7 months; p = 0.016). In multivariable analysis, factors independently associated with worse OS were lymph node metastasis (hazard ratio (HR) 2.07; p < 0.001), postoperative CA19-9 > 37 U/mL (HR 1.94; p < 0.001), intraoperative transfusion (HR 1.74; p = 0.002), advanced T stage (T3, 4) (HR 1.67; p = 0.006). Persistent high CA19-9 level after resection of PHCC with curative intent was associated with poor OS. R1 resection was associated with poor OS especially in non-normalization group. High postoperative CA19-9 value was also independent significant prognostic factor in resected PHCC.