Abstract
BackgroundThe prognostic significance of tumor burden score (TBS) on patients who underwent curative-intent resection of intrahepatic cholangiocarcinoma (ICC) has not been evaluated. The present study aimed to investigate the impact of TBS and its synergistic effect with CA19-9 (combination of TBS and CA19-9, CTC grade) on long-term outcomes.MethodsPatients who underwent radical resection of ICC between 2009 and 2017 were retrospectively identified from a multi-center database. The overall survival (OS) and recurrence-free survival (RFS) were examined in relation to TBS, serum preoperative CA19-9, and CTC grade.ResultsA total of 650 patients were included in our study (509 in the derivation cohort and 141 in the validation cohort). Kaplan–Meier curves showed that both TBS and CA19-9 levels were strong predictors of survival outcomes. Patients with elevated TBS grade or elevated CA19-9 were associated with worse OS and RFS (both p < 0.001). As expected, CTC grade also performed well in predicting long-term outcomes. Patients with low TBS/low CA19-9 (CTC grade 1) were associated with the best OS as well as RFS, while high TBS/high CA19-9 (CTC grade 3) correlated to the worst outcomes. In the validation cohort, TBS grade, preoperative CA19-9, and CTC grade also stratified prognosis among patients (p < 0.001 for each).ConclusionsBoth tumor morphology (tumor burden) and tumor-specific biomarker (serum CA19-9) were important when evaluating prognosis of patients with resectable ICC. Serum CA19-9 and TBS showed a synergistic effect on prognostic evaluation. CTC grade was a promising tool in stratifying prognosis of ICC patients after curative resection.
Highlights
Liver cancer is one of the most commonly diagnosed malignancies and the third leading cause of cancer death worldwide [1]
We explored the correlation between serum Carbohydrate antigen 19-9 (CA19-9) levels and long-term survival outcomes of Intrahepatic cholangiocarcinoma (ICC) patients
We proposed a novel index by combination of tumor burden score (TBS) grade with CA19-9 grade (CTC grade) and analyzed its prognostic effect on predicting patient survival
Summary
Liver cancer is one of the most commonly diagnosed malignancies and the third leading cause of cancer death worldwide [1]. Intrahepatic cholangiocarcinoma (ICC) is cholangiocellular carcinoma originated from intrahepatic bile duct cells, accounting for 5%–20% of primary liver malignancies [2]. The therapeutic strategies for ICC mainly depend on surgical resection and liver transplantation, supplemented by chemotherapy and immunotherapy treatment [7]. Even for surgically treated ICC, the long-term outcome remains unsatisfactory due to rapid progression and frequent incidence of recurrence, with a 5-year survival rate ranging from 30% to 35% [9]. Improving ICC patient prognosis has remained a medical challenge. There is an urgent need for a simple and effective marker for better prediction of ICC patient prognosis, so clinicians can implement individualized treatment at the earliest to improve patient survival. The prognostic significance of tumor burden score (TBS) on patients who underwent curative-intent resection of intrahepatic cholangiocarcinoma (ICC) has not been evaluated. The present study aimed to investigate the impact of TBS and its synergistic effect with CA19-9 (combination of TBS and CA19-9, CTC grade) on long-term outcomes
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