Implications of CA19-9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma: A national cohort analysis.
Implications of CA19-9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma: A national cohort analysis.
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DOI：
10.1002/jso.24381
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发表时间：
2016-09
影响因子：
2.5
通讯作者：
Truty MJ
中科院分区：
文献类型：
--
作者：
Bergquist JR;Ivanics T;Storlie CB;Groeschl RT;Tee MC;Habermann EB;Smoot RL;Kendrick ML;Farnell MB;Roberts LR;Gores GJ;Nagorney DM;Truty MJ
肝内胆管细胞癌(ICCA)和CA19-9升高的患者的最佳处理仍未确定。我们假设CA19-9的升高高于正常表明具有侵袭性的生物学行为，CA19-9的纳入将改善分期辨别能力。对ICCA患者的国家癌症数据库(NCDB-2010-2012)进行了审查，并报告了CA19-9。根据CA19-9高于或低于正常参考范围对患者进行分层。采用非校正Kaplan-Meier和校正Cox比例风险分析进行总体生存(OS)分析。共纳入2816名患者：938名(33.3%)正常；1878名(66.7%)CA19-9水平升高。两组之间的人口统计学/病理学和化疗/放疗相似，但CA19-9升高的患者有更多的淋巴结转移，接受手术的可能性较小。在CA19-9升高的患者中，所有阶段的特定阶段生存率都降低了。CA19-9升高的切除患者围术期结局相似，但长期存活率降低。在调整后的分析中，CA19-9升高独立地预测死亡率的增加，其影响类似于结节阳性、切缘阳性切除和不接受化疗。建议的分期系统包括CA19-9，改善了对AJCC第7版的生存歧视。CA19-9升高是ICCA患者死亡率的独立危险因素，与结节转移和切缘阳性的影响相似。将CA19-9纳入拟议的分期系统增加了歧视。ICCA伴CA19-9升高的患者应考虑综合治疗。
Optimal management of patients with intrahepatic cholangiocarcinoma (ICCA) and elevated CA19-9 remains undefined. We hypothesized CA19-9 elevation above normal indicates aggressive biology and that inclusion of CA19-9 would improve staging discrimination. The National Cancer Data Base (NCDB-2010-2012) was reviewed for patients with ICCA and reported CA19-9. Patients were stratified by CA19-9 above/below normal reference range. Unadjusted Kaplan–Meier and adjusted Cox-proportional-hazards analysis of overall survival (OS) were performed. A total of 2,816 patients were included: 938 (33.3%) normal; 1,878 (66.7%) elevated CA19-9 levels. Demographic/pathologic and chemotherapy/radiation were similar between groups, but patients with elevated CA19-9 had more nodal metastases and less likely to undergo resection. Among elevated-CA19-9 patients, stage-specific survival was decreased in all stages. Resected patients with CA19-9 elevation had similar peri-operative outcomes but decreased long-term survival. In adjusted analysis, CA19-9 elevation independently predicted increased mortality with impact similar to node-positivity, positive-margin resection, and non-receipt of chemotherapy. Proposed staging system including CA19-9 improved survival discrimination over AJCC 7th edition. Elevated CA19-9 is an independent risk factor for mortality in ICCA similar in impact to nodal metastases and positive resection margins. Inclusion of CA19-9 in a proposed staging system increases discrimination. Multi-disciplinary therapy should be considered in patients with ICCA and CA19-9 elevation.
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影响因子：
2.5
作者：
Nathan, Hari;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
DOI：
10.1073/pnas.0402088101
发表时间：
2004-05-25
影响因子：
11.1
作者：
Koike, T;Kimura, N;Kanangi, R
通讯作者：
Kanangi, R
影响因子：
56.9
作者：
KOPROWSKI, H;HERLYN, M;SEARS, HF
通讯作者：
SEARS, HF
影响因子：
3.2
作者：
Hwang, Shin;Lee, Young-Joo;Lee, Sung-Gyu
通讯作者：
Lee, Sung-Gyu
影响因子：
9
作者：
Lang, H;Sotiropoulos, GC;Broelsch, CE
通讯作者：
Broelsch, CE