Tumor markers as a diagnostic key for hilar Cholangiocarcinoma

Abstract

ObjectiveHilar cholangiocarcinoma is the fourth most common gastrointestinal malignancy. CA19-9 and CEA are helpful devices in the management of gastrointestinal malignancies and belong to clinical routine in surgical oncology. But the validity of these parameters in terms of tumor extension and prognosis of bile duct malignancies still remains unclear.MethodsFrom 1998 to 2008, we obtained preoperative CA19-9 and CEA serum levels in 136 patients with hilar cholangiocarcinoma. We correlated tumor stage, resectability rate and survival with preoperative CA 19-9 and CEA serum levels.ResultsCA19-9 (UICC I: 253 ± 561 U/ml; UICC II: 742 ± 1572 U/ml; UICC III: 906 ± 1708 U/ml; UICC IV: 1707 ± 3053 U/ml) and CEA levels (UICC I: 2.9 ± 3.8 U/ml; UICC II: 4.6 ± 6.5 U/ml; UICC III: 18.1 ± 29.6 U/ml; UICC IV: 22.7 ± 53.9 U/ml) increase significantly with rising tumor stage. Patients with pre operative serum levels of CA19-9 (> 1000 U/ml) and CEA (> 14.4 ng/ml) showed a significant poorer resectability rate and survival than patients with lower CA19-9 and CEA serum levels respectively.ConclusionCA19-9 and CEA serum levels are associated with the tumor stage. If preoperatively obtained CA19-9 and CEA serum levels are highly elevated patients have an even worse survival and the frequency of irresectability is significantly higher.

Long-term outcome after surgical resection for cholangiocarcinoma and prognostic index value

“…Some previous studies demonstrated that cancer patients with a high level of serum CEA were associated with poor prognosis. 18,19 This multivariate analysis confirmed that the level of serum CEA above 15 ng/mL was an independent poor prognostic factor and patients with level of serum CEA above 15 ng/mL had a 2.22 times (95%CI: 1.11e2.33) higher mortality risk than those with lower serum level of CEA, which is similar to previous studies. 20 Adjuvant chemotherapy and radiation is a controversial issue in cholangiocarcinoma.…”

A new prognostic scoring system using factors available preoperatively to predict survival after operative resection of perihilar cholangiocarcinoma

“…Additionally, we showed that the score correlated with the histological lymph node status, although the preoperative prediction of nodal metastasis would still be 37 . Some reports have suggested that the serum CEA level is an independent prognostic factor for intrahepatic cholangiocarcinoma [38][39][40] . Nevertheless, there are no previous reports indicating that the preoperative serum CEA level serves as an independent prognostic factor for survival.…”

Prognostic Factors Associated with Preoperative Clinicophysiological Outcomes of Distal Cholangiocarcinoma

“…Yeatman et al [39] further suggested the biliary CEA concentration as a sensitive marker of occult hepatic metastasis and hypothesized that CEA secreted from liver metastases might be transported into both the bile and blood. Other reports have suggested that the serum CEA level is an indepen- 481 dent prognostic factor for perihilar cholangiocarcinoma [23,40] , but not distal cholangiocarcinoma. Notably, Herrera et al [41] reported an increase in preoperative serum CEA levels along with an increasing tumor stage, and concluded that persistently or increasingly elevated CEA levels indicated the presence of metastases.…”