Prognostic relevance of preoperative bilirubin-adjusted serum carbohydrate antigen 19-9 in a multicenter subset analysis of 179 patients with distal cholangiocarcinoma |
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| Authors: | Louisa Bolm Ekaterina Petrova Jürgen Weitz Felix Rückert Uwe A. Wittel Frank Makowiec Hryhoriy Lapshyn Peter Bronsert Bettina M. Rau Igor E. Khatkov Dirk Bausch Tobias Keck Ulrich F. Wellner Marius Distler |
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| Affiliation: | 1. Clinic of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany;2. Dept. for Visceral, Thoracic and Vascular Surgery at the University Hospital, Technical University Dresden, Dresden, Germany;3. Dept. of Surgery, University Medical Center Mannheim, Mannheim, Germany;4. Dept. of General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany;5. Institute for Surgical Pathology, Medical Center – University of Freiburg, Germany;6. Dept. of General, Visceral, and Thoracic Surgery, Municipal Hospital of Neumarkt, Neumarkt i.d.OPf., Germany;7. Dept. of General, Thoracic, Vascular, and Transplantation Surgery, University of Rostock, Rostock, Germany;8. Moscow Clinical Scientific Center, Moscow, Russia;9. Comprehensive Cancer Center Freiburg, Medical Center – University of Freiburg, Germany;10. Faculty of Medicine, University of Freiburg, Germany |
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| Abstract: | BackgroundDistal cholangiocarcinoma (DCC) is a rare malignancy and validated prognostic markers remain scarce. We aimed to evaluate the role of serum CA19-9 as a potential biomarker in DCC.MethodsPatients operated for DCC at 6 high-volume surgical centers from 1994 to 2015 were identified from prospectively maintained databases. Patient baseline characteristics, surgical and histopathological parameters, as well as overall survival after resection were assessed for correlation with preoperative bilirubin-adjusted serum carbohydrate antigen 19-9 (CA19-9). Preoperative CA19-9 to bilirubin ratio (CA19-9/BR) was classified as elevated (≥ 25 U/ml/mg/dl) according to the upper serum normal values of CA19-9 (37 U/ml) and bilirubin (1.5 mg/dl) giving a cut-off at ≥ 25 U/ml/mg/dl.ResultsIn total 179 patients underwent resection for DCC during the study period. High preoperative CA19-9/BR was associated with advanced age and regional lymph node metastases. Median overall survival after resection was 27 months. Elevated preoperative serum CA19-9/bilirubin ratio (HR 1.6, p = 0.025), T3/4 stage (HR 1.8, p = 0.022), distant metastasis (HR 2.5, p = 0.007), tumor grade (HR 1.9, p = 0.001) and R status (HR 1.7, p = 0.023) were identified as independent negative prognostic factors following multivariable analysis.ConclusionElevated preoperative bilirubin-adjusted serum CA19-9 correlates with regional lymph node metastases and constitutes a negative independent prognostic factor after resection of DCC. |
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| Keywords: | Correspondence: Marius Distler Department of General Thoracic and Vascular Surgery Medizinische Fakultät Carl Gustav Carus TU Dresden Fetscherstrasse 74 01307 Dresden Germany. |
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