CEA but not CA19-9 is an independent prognostic factor in patients undergoing resection of cholangiocarcinoma

Abstract

Cholangiocarcinoma (CCA) represents a rare form of primary liver cancer with increasing incidence but dismal prognosis. Surgical treatment has remained the only potentially curative treatment option, but it remains unclear which patients benefit most from liver surgery, highlighting the need for new preoperative stratification strategies. In clinical routine, CA19-9 represents the most widely used tumor marker in CCA patients. However, data on the prognostic value of CA19-9 in CCA patients are limited and often inconclusive, mostly due to small cohort sizes. Here, we investigated the prognostic value of CA19-9 in comparison with other standard laboratory markers in a large cohort of CCA patients that underwent tumor resection. Of note, while CA19-9 and CEA were able to discriminate between CCA and healthy controls, CEA showed a higher accuracy for the differentiation between CCA and patients with primary sclerosing cholangitis (PSC) compared to CA19-9. Furthermore, patients with elevated levels of C-reactive protein (CRP), CA19-9 or CEA showed a significantly impaired survival in Kaplan-Meier curve analysis, but surprisingly, only CEA but not CA19-9 represented an independent predictor of survival in multivariate Cox-regression analysis. Our data suggest that CEA might help to identify CCA patients with an unfavourable prognosis after tumor resection.

Second‐line chemotherapy in biliary tract cancer: Outcome and prognostic factors

“…While CA 19‐9 is well established as a tumour marker in BTC, the tumour marker CEA is predominately used in patients with colon cancer but is frequently elevated in patients with adenocarcinoma of other origin, too. However, the impact of CEA as well as CA 19‐9 levels on survival in BTC is contradictive . One reason for the inconclusive results may be the different cutoff values that were used in the respective studies.…”

Circulating Biomarkers for Cholangiocarcinoma

“…The latter results were corroborated by the fact that patients with a ≥50% decline in CA19–9 level had a better survival than the others (16.0 vs. 9.0 months) [66]. Moreover, we have recently shown that preoperative levels of circulating CEA represent an independent prognostic marker for patients undergoing surgical CCA resection [67]. …”

Diagnostic and prognostic biomarkers in cholangiocarcinoma

“…Similarly, the diagnostic sensitivity and specificity of CEA range from 42% to 85% and 70% to 89% respectively. Increased serum levels of CEA and CA19‐9 have been proposed as an indicator of reduced overall survival in resectable or inoperable CCAs . However, while an important number of studies describe CEA and CA19‐9 as independent prognostic markers, prognostic cut‐off values vary significantly between reports and large meta‐analyses are still lacking.…”

“…For CA19‐9, the most recent data resulting from a large meta‐analysis described a pooled sensitivity and specificity of 72% and 84%, respectively, regarding the distinction between CCA and healthy controls or patients with benign biliary disease . Similarly, the diagnostic sensitivity and specificity of CEA range from 42% to 85% and 70% to 89% respectively. Increased serum levels of CEA and CA19‐9 have been proposed as an indicator of reduced overall survival in resectable or inoperable CCAs .…”