Clinical value of preoperative CA19‐9 levels in evaluating resectability of gallbladder carcinoma

Abstract

Background: This study evaluated the predictive ability of preoperative carbohydrate antigen 19-9 (CA19-9) level in assessing tumour resectability in patients with gallbladder carcinoma (GBC). Methods: We retrospectively analysed preoperative serum levels of CA19-9 in 292 patients with potentially resectable GBC between January 2000 and March 2016 in our institution. All final diagnoses were confirmed by pathological examination. The optimal cut-off point of the CA19-9 for predicting resectability was determined by the receiver operating characteristic curve. The univariate analysis and multivariate Cox regression model were applied to assess the relationship between the parameters to resectability. Results: A total of 292 patients with surgical treatment were included, of whom 195 were identified as curative resection (R0 resection), 69 were classified as R1/2 resection and the remaining 28 patients were operated on with palliative surgery. The receiver operating characteristic curve analysis calculated the best CA19-9 cut-off point of 98.91 U/mL in the prediction of resectability. Meanwhile, the sensitivity, specificity, positive predictive value and negative predictive value were 76.3%, 70.8%, 85.7% and 56.5%, respectively. In the multivariate logistic regression analysis, CA19-9 >98.91 U/mL (odds ratio (OR) 6.339, 95% confidence interval (CI) 3.562-11.284, P < 0.001), tumour located on hepatic side (OR 1.787, 95% CI 1.022-3.123, P = 0.042) and advanced American Joint Committee on Cancer stage (OR 2.156, 95% CI 1.180-3.940, P = 0.013) were independent determinants of resectability in patients diagnosed as GBC. Conclusion: Preoperative CA19-9 predicts resectability in patients with radiological resectable GBC. Increased preoperative CA19-9 is related to poor resectability rate. © 2018 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E76-E80 ANZJSurg.com © 2018 Royal Australasian College of Surgeons E80Liu et al.

Raised CA19–9 and CEA have prognostic relevance in gallbladder carcinoma

“…In our study the cutoff value of CA19–9 > 72 and CEA > 5 had high specificity but low sensitivity in detection of metastatic disease with a AUROC of 0.67 and 0.62 for CA19–9 and CEA respectively. Liu et al [ 13 ] found cut-off levels CA19–9 of 98.9 IU/ml, an independent predictor of resectability in GBC patients who underwent attempted resection with a sensitivity of 76.3% and specificity of 70.8%. They showed CA19–9 levels may predict R0 resection.…”

The Clinical Role of Preoperative Serum CA19-9 and Carcinoembryonic Antigen (CEA) Levels in Evaluating the Resectability of Advanced Gallbladder Cancer

“…Serum CEA and CA19-9 concentrations may also predict the resectability of pancreatic cancers [ 31 – 33 ], whereas preoperative measurements of serum CEA, CA125, and CA19-9 concentrations can assist in evluating the resectability of cholangiocarcinomas, a type of biliary tract cancer [ 12 ]. Moreover, a study of 292 patients with stage I–IV GBC reported that preoperative CA19-9 could predict tumor resectability [ 13 ], although that study did not consider the effect of tumor-associated elevation of total bilirubin concentration on serum levels of CEA and CA19-9.. The radical resection rate of stage 0-I GBC is high, with these patients having a 5-year survival rate over 60% [ 15 , 19 ].…”

“…Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are cancer-associated antigens, measurements of which have been widely used to determine the diagnosis and prognosis of patients with tumors of the digestive system, including pancreatic [ 7 ], bile duct [ 8 ], colorectal [ 9 ], and gastric [ 10 ] cancer. Moreover, measurements of CEA and CA19-9 concentrations can be used to evaluate the resectability of various cancers [ 11 , 12 ], including GBCs [ 13 ]. Radical resection is possible in most patients with early stage GBC (stage 0–I, AJCC 8 th ), with a satisfactory prognosis [ 14 , 15 ].…”

Impact of surgical strategies on the survival of gallbladder cancer patients: analysis of 715 cases

“…The Cox hazard proportional regression analysis showed that advanced tumor stages, high levels of CA199, and tumor location in gallbladder body or neck would indicate a poor prognosis. Studies have reported that CA199 is a prognosis related marker [21,28,29]. Moreover, Wang et al have reported that tumor location in gallbladder neck could be a prognosisrelated marker [21].…”