Elevation of CA19-9 and CEA is associated with a poor prognosis in patients with resectable gallbladder carcinoma

Zhu, Wen; Si, Anfeng; Yang, Jing; Yang, Pinghua; Yang, Xinwei; Liu, Hu; Xing, Yan; Li, Wengang; Zhang, Baohua

doi:10.1016/j.hpb.2017.06.011

Cited by 40 publications

(29 citation statements)

References 21 publications

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“…CA 19-9 has been studied as a prognostic marker in resectable GBC where it has shown to be of statistically significant benefit. 9,12,13 However, it has not been evaluated before in prognostication of advanced/ metastaic disease status except in one study which inculded all biliary tract malignancies. 14 In this study, there were about 25% GBC patients and the analysis was not done for these patients separately.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of CA19-9 and CA242 in Gallbladder Cancer - An Exploratory Study

Agarwal¹,

Tiwari²,

Kumari³

et al. 2019

IJCMR

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Introduction: There are, at present, no biomarkers to predict to prognosis of Gallbladder cancer. We conducted a prospective exploratory study to evaluate the role to serum CA 19-9 and CA 242 as prognostic markers. Material and Methods: We enrolled consecutive patients for this study and CA 19-9 and 242 were estimated from venous samples. Association of these markers with clinical variables and median overall survival (OS) difference between patients who has raised versus normal levels of these markers was determined. Results: Sixty-two patients were enrolled for this study. Forty-four (71%) patients had elevated CA19-9. Thirty-nine (62.9%) patients had an raised CA242 levels. CA 19-9 was found to be significantly associated with the presence of jaundice (p=0.038) and advanced stage (p=0.009). Median OS of patients who had elevated CA 19-9 was 5.73 months compared to 8.33 months in patients who had normal CA 19-9. The difference was not statistically different (p= 0.15). Median OS for patients who had elevated CA 242 was 5.53 months, which was inferior to those who had normal levels (9.1 months). This difference approached, but was not statistically significant (p=0.055). Conclusion: This is the first study to show association between CA 19-9 and stage of disease in GBC. At present, CA 19-9 and CA 242 cannot be recommended as prognostic markers. However, role of CA 242 needs to be examined in a larger cohort of patients of GBC to establish its usefulness.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of CA19-9 and CA242 in Gallbladder Cancer - An Exploratory Study

Agarwal¹,

Tiwari²,

Kumari³

et al. 2019

IJCMR

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“…These variables were chosen based on prior literature, as well as biological and clinical plausibility. CA 19-9 level has been found to be an independent predictor of poor survival in patients with biliary tree malignancies 18 and GBC specifically, 19 and baseline CA 19-9 level may predict the burden of disease in GBC, particularly above 20 units per milliliter. 20 CA 19-9 level also has been validated as a predictive marker for positive SL in potentially resectable pancreatic cancer, 21 but to our knowledge, this study is the first demonstration of the predictive significance of CA 19-9 in SL for potentially resectable EHBT.…”

Section: Resultsmentioning

confidence: 98%

Staging laparoscopy among three subtypes of extra‐hepatic biliary malignancy: a 15‐year experience from 10 institutions

Davidson

Jin

Krasnick

et al. 2018

Journal of Surgical Oncology

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Background Staging laparoscopy (SL) is used to avoid resection failure and thus increase the curative resection rate. SL utilization in extra‐hepatic biliary tumors (EHBT) is variable. Methods Data from 1090 patients with potentially resectable EHBT including gallbladder (GBC), distal (DC), and hilar (HC) subtypes were retrospectively collected from 10 academic centers (2000‐2015). Results The SL utilization rate increased over time and was significantly higher in GBC than DC and HC. SL yield was 16.8% and did not differ between groups or over time. In patients undergoing attempted resection with prior SL, the curative resection rate did not differ between subtypes. In patients undergoing attempted resection without prior SL, the curative resection rate was less in GBC compared with DC or HC. After matching cohorts by inverse probability weighting, prior SL was associated with curative resection in GBC only (odds ratio [OR], 2.41, 95% CI, 1.36‐4.27). On multivariable regression analysis, elevated carbohydrate antigen 19‐9 (CA 19‐9), low serum albumin, and GBC were strong predictors of distant disease on SL. After categorizing patients undergoing SL into low, intermediate, and high‐risk groups based on these parameters, SL yield improved progressively from 10.0% to 19.6% to 52.6%. Conclusions We recommend routine SL for patients with GBC, particularly with elevated CA19‐9 level and/or decreased serum albumin.

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“…Only a few reports have revealed the clinical usefulness of the preoperative CA19-9 level in GBCa alone [20-22]. Wen et al [20] compared the survival of GBCa patients using a cutoff value of 37 U/mL, which is the upper limit of normal CA19-9. However, this value may not be the best cutoff point in terms of the influence on survival or biological malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…It is now promoted as a reliable test marker for the detection and prognostication of bile duct cancer [15-19]. Although some authors have discussed the utility of the preoperative CA19-9 level based on the upper limit in patients with GBCa [20-22], the optimal evidence-based cutoff value of CA19-9 in terms of prognosis or biological malignancy for detecting advanced GBCa patients who can avoid upfront surgery has not been clarified.…”

Section: Introductionmentioning

confidence: 99%

Surgical Indication for Advanced Gallbladder Cancer Considering the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value

et al. 2020

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Background: Selecting patients who will benefit from resection among those with advanced gallbladder cancer (GBCa) having poor prognostic factors is difficult. Methods: One hundred twenty-one patients who underwent resection for stage II-IV GBCa and 19 unresected patients (unresectable group) were enrolled. The clinical impact of carbohydrate antigen 19-9 (CA19-9) and advanced surgical procedures for GBCa was evaluated. Results: The optimal CA19-9 cutoff value (based on the greatest difference in overall survival) was 250 U/mL. CA19-9 ≥250 U/mL was found to be an independent prognostic factor. Patients with CA19-9 <250 U/mL who developed jaundice (median survival time [MST], 49.1 months) or who required major hepatectomy (MST, 21.5 months) or pancreatoduodenectomy (PD; MST, 50.3 months) had a better prognosis than those with CA19-9 ≥250 U/mL who developed jaundice (MST, 16.1 months; p = 0.061) or who required major hepatectomy (MST, 9.2 months; p = 0.066) or PD (MST, 8.6 months; p = 0.025); their prognosis was comparable to that of the unresectable group (jaundice: p = 0.145, major hepatectomy: p = 0.292, PD: p = 0.756). Conclusions: Even if GBCa patients develop jaundice or require major hepatectomy, or combined PD, resection can be considered for those with CA19-9 <250 U/mL. However, surgical indication should be carefully determined in patients with CA19-9 ≥250 U/mL.

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Elevation of CA19-9 and CEA is associated with a poor prognosis in patients with resectable gallbladder carcinoma

Abstract: A combination of an elevated preoperative CEA and CA19-9 was associated with a worse prognosis for patients with GBC who underwent resection.

Cited by 40 publications

References 21 publications

Prognostic Value of CA19-9 and CA242 in Gallbladder Cancer - An Exploratory Study

Prognostic Value of CA19-9 and CA242 in Gallbladder Cancer - An Exploratory Study

Staging laparoscopy among three subtypes of extra‐hepatic biliary malignancy: a 15‐year experience from 10 institutions

Surgical Indication for Advanced Gallbladder Cancer Considering the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value

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