A new strategy for the application of CA19-9 in the differentiation of pancreaticobiliary cancer: analysis using a receiver operating characteristic curve

Kim, H

doi:10.1016/s0002-9270(99)00290-7

Cited by 28 publications

(36 citation statements)

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“…We used ROC curve for the statistical analysis of bilirubin and CA 19-9 levels ROC curve has been extensively used by Hong-Ja Kim et al in their statistical analysis of CA 19-9 in various pancreatico-biliary diseases [12]. In our study, cut off for bilirubin and CA 19-9 levels obtained by ROC were 3mg/dl and 35U/ml respectively.…”

Section: Discussionmentioning

confidence: 95%

Predictors of malignancy in pancreatic head mass: a prospective study

Sivarman¹,

Muthukrishnan²,

Senguttvan³

et al. 2011

Pan Afr Med Jrnl

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IntroductionThe objective of the study was to identify the predictive factors for malignancy in pancreatic head mass as a primary outcome and assess the value of CA 19-9 as a diagnostic tool for malignancy as a secondary outcome.MethodsA prospective study of patients presented with pancreatic head mass was conducted in a tertiary care referral hospital, Manipal, India from May 2006 to November 2008. The study population was divided into malignant and benign groups based on the final histopathology report. A univariate and multivariate analysis of potential predictive factors for malignancy were conducted.ResultsA total of 102 patients with pancreatic head mass were included in the study after fulfilling the inclusion/exclusion criteria. 78 were malignant and 24 were benign. There was significant weight loss (p<0.001) and high mean bilirubin levels (p=0.002) in the malignant group. Mean CA 19-9 was significantly higher in the malignant group (290.7 vs. 30.3 U/ml; p<0.001). Sensitivity and specificity of CA 19-9 for detecting malignancy in pancreatic head mass at a cut off of 35U/ml was 86% and 79% respectively. CA 19-9 positivity rate was higher with increasing cut off values of 100, 200 and 300U/ml but such high levels occurred in fewer patients. All the non-jaundiced patients (100%) with raised CA 19-9 levels were found to be malignant compared to 86% malignancy in jaundiced patients. In multivariate analysis, a combination of weight loss>10% of body weight and bilirubin>3 mg/dl and CA 19-9>35U/ml had specificity and positive predictive value of 100% for predicting malignancy in pancreatic head mass.ConclusionThe presence of weight loss and jaundice and raised CA 19-9 levels together in a patient with pancreatic head mass can be predictive of malignancy. A very high CA 19-9 level can be an indicator of malignancy in a pancreatic head mass. A raised CA 19-9 level may be more predictive of malignancy in non-jaundiced patients than in jaundiced patients.

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Section: Discussionmentioning

confidence: 95%

Predictors of malignancy in pancreatic head mass: a prospective study

Sivarman¹,

Muthukrishnan²,

Senguttvan³

et al. 2011

Pan Afr Med Jrnl

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“…However, CA 19-9 above 150 U/mL was poor prognostic factor in only univariate analysis (Table 4). Although some tumor markers have been investigated to diagnose cholangiocarcinoma31-35 and predict post-operative prognosis or recurrence,36-38 to our knowledge this is the first study to investigate the prognostic capability of tumor markers in cholangiocarcinoma patients without any surgery, chemotherapy or radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we could not evaluate the immediate causes of death exactly. In addition, cut-off values of tumor markers were determined arbitrarily because it was not possible to calculate the Receiver Operating Characteristic (ROC) curve due to the death of all patients and the range of tumor markers from the previous studies35-38 was too wide to determine appropriate reference values. Despite these limitations, this is the largest study to date regarding this topic and all data were obtained from a single institute making data interpretation more reliable.…”

Section: Discussionmentioning

confidence: 99%

Natural History and Prognostic Factors of Advanced Cholangiocarcinoma without Surgery, Chemotherapy, or Radiotherapy: A Large-Scale Observational Study

Park¹,

Kim²,

Kim³

et al. 2009

Gut Liver

165

117

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Background/AimsWe aimed to evaluate survival time and prognostic factors in patients with advanced unresectable cholangiocarcinoma who have not received surgery, chemotherapy, or radiotherapy.MethodsA total of 1,377 patients, who were diagnosed with primary cholangiocarcinoma between 1996 and 2002, were reviewed retrospectively according to the following inclusion criteria: histologically proven primary adenocarcinoma arising from the bile-duct epithelium, advanced unresectable stages, no severe comorbidity that can affect survival time, and no history of surgery, chemotherapy, or radiotherapy.ResultsOf the 1,377 cases reviewed, 330 patients complied with the inclusion criteria and were thus eligible to participate in this study; 203 had intrahepatic cholangiocarcinoma and 127 had hilar cholangiocarcinoma. The overall survival time of the entire cohort (n=330) was median 3.9 months (range; 0.2 to 67.1). The survival time was significantly shorter in the intrahepatic cholangiocarcinoma group (3.0±5.3 months) than in the hilar cholangiocarcinoma group (5.9±10.1 months; Kaplan-Meier survival analysis). Multivariate analysis revealed that distant metastasis was a poor prognostic factor for intrahepatic cholangiocarcinoma (p< 0.001), baseline serum albumin >3.0 g/dL was a favorable prognostic factor (p=0.02), and baseline serum carcinoembryonic antigen level >30 ng/mL was a poor prognostic factor for hilar cholangiocarcinoma (p=0.01).ConclusionsThe median survival of advanced unresectable cholangiocarcinoma is dismal.

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“…These results including our study suggest that CA19-9 is sufficient marker for predicting prognosis as well as marker for tracking cancer recurrence. However, the value of CA19-9 is known to be influenced by cholestasis[15], and it is known that the higher the pre-treatment value, the worse the prognosis[14,16]. Therefore, we conducted a univariate and multivariate analysis using a Cox proportional hazard model with a category of more than 3 mg/dL of total bilirubin (bilirubin ≥ 3) and more than 300 U/mL of CA19-9 (CA19-9 ≥ 300) based on the results of Kim et al[15].…”

Section: Discussionmentioning

confidence: 99%

Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma

Jung¹,

Lee²,

Lee³

et al. 2017

WJG

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AIMTo clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging.RESULTSThe median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (P = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (P = 0.01).CONCLUSIONNACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.

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A new strategy for the application of CA19-9 in the differentiation of pancreaticobiliary cancer: analysis using a receiver operating characteristic curve

Abstract: The use of CA19-9 for the differentiation of pancreaticobiliary cancer should be applied individually, depending on the clinical situation.

Cited by 28 publications

References 0 publications

Predictors of malignancy in pancreatic head mass: a prospective study

Predictors of malignancy in pancreatic head mass: a prospective study

Natural History and Prognostic Factors of Advanced Cholangiocarcinoma without Surgery, Chemotherapy, or Radiotherapy: A Large-Scale Observational Study

Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma

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