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. 2010 Mar;12(2):134-8.
doi: 10.1111/j.1477-2574.2009.00149.x.

Elevated CA 19-9 portends poor prognosis in patients undergoing resection of biliary malignancies

Ioannis Hatzaras  1 , Carl Schmidt, Peter Muscarella, W Scott Melvin, E Christopher Ellison, Mark Bloomston
Affiliations

Elevated CA 19-9 portends poor prognosis in patients undergoing resection of biliary malignancies

Ioannis Hatzaras et al. HPB (Oxford). 2010 Mar.

Abstract

Background: Biliary tree malignancies including cholangiocarcinoma and gallbladder cancer are aggressive cancers with a high disease-specific mortality despite resection. The aim of the present study was to identify predictors of survival after resection.

Methods: A retrospective review of all patients that underwent radical resection of biliary malignancies was performed. Demographics, elevated CA19-9 (>35 U/ml), treatment and outcome data were collected and compared according to tumour location. Kaplan-Meier survival curves were created and compared using log-rank analysis. Multivariate analysis was undertaken using Cox proportional hazards regression.

Results: Ninety-one patients with biliary malignancies underwent surgical resection between 1992 and 2007. There were 46 (50.5%) extrahepatic cholangiocarcinomas (EHC), 23 (25.2%) intrahepatic cholangiocarcinomas (IHC) and 22 (24.2%) gallbladder carcinomas (GBC). The median (range) age was 64 (24-92) years. An elevated CA19-9 was recorded in 45 (55%) patients (52% of IHC, 63% of EHC, and 41% of GBC). The overall median (range) survival was 22.5 (0.3-153.3) months. All three groups were similar in terms of age, gender, pre-operative CA 19-9 level, completeness of resection and tumour histopathological characteristics. GBC were associated with the shortest median survival (14.3 months) followed by EHC (24.8 months) and IHC (30.4 months); however, this did not meet statistical significance (P= 0.971). Only elevated pre-operative CA 19-9 level (>35 U/ml) was predictive of poor median survival by univariate (P= 0.003) and multivariate analysis (15.1 months vs. 67.4, P= 0.047).

Conclusions: Elevated pre-operative CA 19-9 levels were found to be independent predictors of poor survival after attempted resection for biliary tree malignancies. It is recommended that CA19-9 be routinely measured prior resection.

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Figures

Figure 1
Figure 1
Cumulative survival by high CA 19-9 levels. Table depicts patients at risk at each time interval
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