Preoperative CEA levels are supplementary to CA19-9 levels in predicting prognosis in patients with resectable intrahepatic cholangiocarcinoma

Abstract

Background: There are few diagnostic tools that can be used to determine which patient with intrahepatic cholangiocarcinoma (ICC) can benefit from surgery actually, highlighting that the need for new preoperative stratification strategies. The aim of this study was to investigate the predictive values of preoperative biomarkers in survival analyses for patients with ICC after surgical resection.Methods: A total of 285 patients with ICC were retrospectively reviewed. Receiver operating charateristics (ROC) curves were used to evaluate the predictive effects of preoperative carbohydrate antigen 19-9 (CA19-9) with different cutoff values and carcinoembryonic antigen (CEA) in patients with ICC.Results: Preoperative CA19-9 with a cutoff value of 200 U/ml performed better in predicting overall survival (OS) and progression free survival (PFS) in ICC patients. Patients with preoperative CA19-9 value > 200 U/ml generally had a poor surgical response. However, surgical resection could also benefit patients whose CA19-9 levels decreased postoperatively or preoperative CEA levels were negative.Conclusions: With the cutoff value of 200U/ml, CA19-9 was a better preoperative biomarker for predicting survival for ICC patients after surgical resection. Combination of preoperative CA19-9 and CEA showed the strongest predictive power in survival analyses in these patients and should be recognized in daily clinical care.

Survival prediction for patients with non-resectable intrahepatic cholangiocarcinoma undergoing chemotherapy: a retrospective analysis comparing the tumor marker CA 19-9 with cross-sectional imaging

“…While several studies have previously shown prognostic value in baseline CA 19-9 serum levels with regard to survival (Ali et al 2007;Bolm et al 2019;Coelho et al 2017;He et al 2018;Jiang et al 2011), studies investigating CA 19-9 kinetics in patients with ICC undergoing chemotherapy are scarce. A study by Harder et al investigated 70 patients with biliary tract cancers, among them 33 patients with ICC.…”

“…Besides having diagnostic value, CA 19-9 has repeatedly been shown to be useful in predicting the overall survival (OS) or progression-free survival of patients with ICC. However, there is disagreement about the optimal cut-off value that identifies patients with poor prognosis, with proposed cut-offs ranging from 37 to 1000 U/ml (Ali et al 2007;Bolm et al 2019;Coelho et al 2017;He et al 2018;Jiang et al 2011). Regarding the influence of CA 19-9 changes on survival in patients undergoing chemotherapy, a literature search yielded only two studies that focused on this issue.…”

Serum Carbohydrate Antigen 199 as a Biomarker for Evaluating Patients with Choledocholithiasis

“…First discovered in human colorectal cancer cells, CA199 has since been found to be produced by a range of normal epithelial cell types, including those in the pancreas and the bile ducts [9]. In the current clinical practice, CA199 levels are commonly used as a biomarker of malignant tumors of the biliary tract and pancreas [10]. In most benign diseases, CA199 levels remain low, although levels in patients affected benign obstructive jaundice (including choledocholithiasis, cholangitis, and Mirizzi syndrome) are elevated [11,12].…”

CD86+/CD206+ tumor-associated macrophages predict prognosis of patients with intrahepatic cholangiocarcinoma

“…Notably, several ICC prognostic studies indicated that preoperative serum CA-199 level was a significant prognostic indicator for ICC patients after hepatectomy (Bergquist et al, 2016;He et al, 2018;Juntermanns et al, 2010;Kondo et al, 2014;Zheng et al, 2017).…”

“…Resected patients with CA19-9 elevation had similar peri-operative outcomes but decreased long-term survival (Bergquist et al, 2016). However, some ICC patients with low preoperative serum level of CA-199 was associated with rapid disease progression (He et al, 2018). Worse yet, a reliable tumor marker to distinguish the prognosis of CA-199 negative ICC patients remains limited.…”