Image_1_Importance of Normalization of Carbohydrate Antigen 19-9 in Patients With Intrahepatic Cholangiocarcinoma.jpeg
Although 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.
History
References
- https://doi.org//10.3322/caac.21660
- https://doi.org//10.1016/s0140-6736%2821%2900153-7
- https://doi.org//10.1007/s00268-019-04966-4
- https://doi.org//10.1002/bjs.10676
- https://doi.org//10.1016/j.jhep.2019.10.009
- https://doi.org//10.1155/2019/6016931
- https://doi.org//10.1200/jco.2012.41.5984
- https://doi.org//10.1111/jgh.14124
- https://doi.org//10.1007/s00595-020-01992-x
- https://doi.org//10.1155/2015/298985
- https://doi.org//10.1245/s10434-020-08350-8
- https://doi.org//10.1007/s11605-016-3149-4
- https://doi.org//10.1097/sla.0000000000003049
- https://doi.org//10.1245/s10434-014-3842-z
- https://doi.org//10.1093/annonc/mdx495
- https://doi.org//10.1111/j.1365-2125.2004.02103.x
- https://doi.org//10.1016/j.clnu.2021.04.038
- https://doi.org//10.1001/jamaoncol.2017.4420
- https://doi.org//10.1002/%28sici%291097-0258%2819991130%2918%3A22%3C3075%3A%3Aaid-sim244%3E3.0.co;2-6
- https://doi.org//10.21037/atm.2020.01.72
- https://doi.org//10.1016/j.jhep.2014.01.021
- https://doi.org//10.29271/jcpsp.2019.10.962
- https://doi.org//10.1016/j.jhep.2013.02.013
- https://doi.org//10.1016/s1470-2045%2818%2930915-x
- https://doi.org//10.1200/jco.18.00050
- https://doi.org//10.1177/172460089400900107