The Impact of Preoperative CA19-9 and CEA on Outcomes of Patients with Intrahepatic Cholangiocarcinoma
The Impact of Preoperative CA19-9 and CEA on Outcomes of Patients with Intrahepatic Cholangiocarcinoma
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DOI：
10.1245/s10434-020-08350-8
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发表时间：
2020-03-20
影响因子：
3.7
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
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作者：
Moro, Amika;Mehta, Rittal;Pawlik, Timothy M.
背景本研究的目的是评估血清CA 19 -9和CEA及其联合对肝内胆管癌（ICC）手术患者生存率的影响。方法使用多机构数据库确定1990年至2016年期间接受ICC根治性切除术的患者。基于血清CA 19 -9和CEA的组合（低vs.高）将患者分为四组。与肝切除术后1年死亡率相关的因素进行了研究。结果低CA 19 -9/低CEA组5年OS（54.5%）明显高于低CA 19 - 9/高CEA组（14.6%）、高CA 19 -9/低CEA组（10.0%）和高CA 19 -9/高CEA组（0%）（P < 0.001）。高CA 19 -9（高CA 19 -9/低CEA：70.4%）或高CEA水平（低CA 19 -9/高CEA：72.5%）患者的1年OS无差异（P = 0.92）。尽管具有最有利的肿瘤标志物特征（低CA 19 -9/低CEA）的患者具有最好的1年生存率（87.9%），但仍有15.1%（n = 39）的患者在手术后1年内死亡。在低CA 19 -9/低CEA患者中，高嗜中性粒细胞/淋巴细胞比（NLR）（比值比1.09; 95%置信区间1.03-1.64）和大肿瘤（比值比3.34; 95%置信区间1.40-8.10）与1年死亡率相关（P < 0.05）。结论高CA 19 -9和/或高CEA患者1年生存率低。高NLR和大肿瘤大小与具有良好肿瘤标志物特征的患者的1年死亡率风险较高相关。
Background The objective of the current study was to assess the impact of serum CA19-9 and CEA and their combination on survival among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC). Methods Patients who underwent curative-intent resection of ICC between 1990 and 2016 were identified using a multi-institutional database. Patients were categorized into four groups based on combinations of serum CA19-9 and CEA (low vs. high). Factors associated with 1-year mortality after hepatectomy were examined. Results Among 588 patients, 5-year OS was considerably better among patients with low CA19-9/low CEA (54.5%) compared with low CA19-9/high CEA (14.6%), high CA19-9/low CEA (10.0%), or high CA19-9/high CEA (0%) (P < 0.001). No difference in 1-year OS existed between patients who had either high CA19-9 (high CA19-9/low CEA: 70.4%) or high CEA levels (low CA19-9/high CEA: 72.5%) (P = 0.92). Although patients with the most favorable tumor marker profile (low CA19-9/low CEA) had the best 1-year survival (87.9%), 15.1% (n = 39) still died within a year of surgery. Among patients with low CA19-9/low CEA, a high neutrophil-to-lymphocyte ratio (NLR) (odds ratio 1.09; 95% confidence interval 1.03-1.64) and large size tumor (odds ratio 3.34; 95% confidence interval 1.40-8.10) were associated with 1-year mortality (P < 0.05). Conclusions Patients with either a high CA19-9 and/or high CEA had poor 1-year survival. High NLR and large tumor size were associated with a greater risk of 1-year mortality among patients with favorable tumor marker profile.