Can preoperative and postoperative CA19-9 levels predict survival and early recurrence in patients with resectable hilar cholangiocarcinoma?
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Jun-Ke Wang1,*, Hai-Jie Hu1,*, Anuj Shrestha1,2, Wen-Jie Ma1, Qin Yang1, Fei Liu1, Nan-Sheng Cheng1, Fu-Yu Li1
1Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
2Department of General Surgery, Gandaki Medical College, Pokhara, Nepal
*These authors contributed equally to this work
Fu-Yu Li, email: [email protected]
Keywords: hilar cholangiocarcinoma, CA19-9, prognosis, early recurrence
Received: October 07, 2016 Accepted: April 11, 2017 Published: April 21, 2017
Background: To investigate the predictive values of preoperative and postoperative serum CA19-9 levels on survival and other prognostic factors including early recurrence in patients with resectable hilar cholangiocarcinoma.
Results: In univariate analysis, increased preoperative and postoperative CA19-9 levels in the light of different cut-off points (37, 100, 150, 200, 400, 1000 U/ml) were significantly associated with poor survival outcomes, of which the cut-off point of 150 U/ml showed the strongest predictive value (both P < 0.001). Preoperative to postoperative increase in CA19-9 level was also correlated with poor survival outcome (P < 0.001). In multivariate analysis, preoperative CA19-9 level > 150 U/ml was significantly associated with lymph node metastasis (OR = 3.471, 95% CI 1.216–9.905; P = 0.020) and early recurrence (OR = 8.280, 95% CI 2.391–28.674; P = 0.001). Meanwhile, postoperative CA19-9 level > 150 U/ml was also correlated with early recurrence (OR = 4.006, 95% CI 1.107–14.459; P = 0.034).
Materials and Methods: Ninety-eight patients who had undergone curative surgery for hilar cholangiocarcinoma between 1995 and 2014 in our institution were selected for the study. The correlations of preoperative and postoperative serum CA19-9 levels on the basis of different cut-off points with survival and various tumor factors were retrospectively analyzed with univariate and multivariate methods.
Conclusions: In patients with resectable hilar cholangiocarcinoma, serum CA19-9 predict survival and early recurrence. Patients with increased preoperative and postoperative CA19-9 levels have poor survival outcomes and higher tendency of early recurrence.
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