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group 1: preoperative normal CA19-9

group 2: high preoperative and normalized postoperative CA19-9

group 3: high pre- and postoperative CA19-9

Abstract

BACKGROUNDS:
Perioperative CA19-9 value in pancreato-biliary cancers has been recognized as a prognostic factor. Herein, we investigated survival differences and recurrence patterns after adjuvant chemoradiotherapy by perioperative CA19-9 change in surgically resected extrahepatic cholangiocarcinoma.

METHODS:
Patients were divided into those with preoperative normal CA19-9 (Group 1, n = 52), those with high preoperative and normalized postoperative CA19-9 (Group 2, n = 80), and those with both high pre- and postoperative CA19-9 (Group 3, n = 21).

RESULTS:
Depending on the group defined above, the 5-year overall survival (OS) (59.6%, 38.7%, and 9.5%, P < 0.001) and disease-free survival (55.8%, 31.2%, and 9.5%, P < 0.001) between the three groups differed. On multivariable analysis in patients other than group 1, poor prognosticators for OS were high postoperative CA19-9 (HR 2.26, P = 0.008) and N1 disease (HR 2.33, P = 0.001). Group 3, compared with group 2, showed higher distant metastasis rate, shorter disease-free interval, and higher CA19-9 at the time of recurrence.

CONCLUSIONS:
Survival and recurrence patterns after adjuvant chemoradiotherapy are significantly affected by perioperative CA19-9 change. This may have important implications in patient selection for adjuvant chemoradiotherapy and clinical trial design.

Author information

Kim BH1, Kim E1, Kim K2, Jang JY3, Kim SW3, Oh DY4, Chie EK1.
1
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
2
Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
3
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
4
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.