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Background: Prognosis of cholangiocarcinoma is still unsatisfactory, and identification of predictive marker of survival after surgical resection is important to establish the perioperative therapeutic strategy for cholangiocarcinoma. Impact of perioerative serum carbohydrate antigen 19-9 (CA19-9) levels on survival of patients with resectable cholangiocarcinoma is still unclear.
Purpose: The purpose of this study was to investigate whether perioerative serum CA19-9 levels can predict survival of patients underwent surgical resection for cholangiocarcinoma.
Methods: One hundred and six patients with cholangiocarcinoma including 33 with intrahepatic, 48 with perihilar and 25 with distal cholangiocarcinoma who underwent surgical resection between 2002 and 2012 were eligible for this study. Preoperative biliary drainage was performed for the patients with obstructive jaundice. Preoperative serum CA19-9 levels were measured after biliary drainage, and postoperative serum CA19-9 levels were measured about 4 weeks after operation. The relationships between clinicopathological factors including perioperative serum CA19-9 levels and overall survival (OS) were analyzed with univariate and multivariate analyses.
Results: Preoperative CA19-9 levels were significantly higher in patients with moderately and poorly differentiated adenocarcinoma than in those with well differentiated adenocarcinoma (P = 0.009), and in patients with UICC stage I/II than those with III/IV (P = 0.008). In contrast, there was no significant difference between postoperative CA19-9 and any other clinicopathological factors. Univariate analysis revealed postoperative adjuvant chemotherapy (P = 0.03), residual tumor factor status (P = 0.01), pathological differentiation (P = 0.02), UICC pT stage (P = 0.009), lymph node metastasis (P < 0.001) and UICC final stage (P = 0.001) were significantly associated with OS. In addition, differences in OS were significant between groups divided on the basis of two preoperative CA19-9 cutoff values (37 and 200 U/ml), and three postoperative CA19-9 cutoff values (37, 100 and 200 U/ml). In multivariate analysis, no postoperative adjuvant chemotherapy (odds ratio [OR], 3.02: 95% confidence interval [CI], 1.54 - 5.89; P = 0.001), lymph node metastasis (OR, 3.96; 95% CI, 1.91 - 8.48; P < 0.001), preoperative CA19-9 (≥200 IU/ml) (OR, 2.27; 95% CI, 1.10 - 4.61; P = 0.03) and postoperative CA19-9 (≥37 IU/ml) (OR, 6.88; 95% CI, 3.36 - 14.41; P < 0.001) were identified as independent predictors for OS.
Conclusion: Perioperative serum CA19-9 levels predict the survival of patients with resectable cholangiocarcinoma, and they may contribute to establishment of new therapeutic strategy, as perioperative treatment can be optimized based on its value.