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

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

Research output: Contribution to journalArticle

38 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)134-138
Number of pages5
JournalHPB
Volume12
Issue number2
DOIs
StatePublished - Mar 2010
Externally publishedYes

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Cholangiocarcinoma
Gallbladder
Survival
Neoplasms
Biliary Tract
Carcinoma
Multivariate Analysis
Gallbladder Neoplasms
Kaplan-Meier Estimate
Demography
Mortality

Keywords

  • Cholangiocarcinoma
  • Gallbladder cancer

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Elevated CA 19-9 portends poor prognosis in patients undergoing resection of biliary malignancies. / Hatzaras, Ioannis; Schmidt, Carl; Muscarella, Peter; Melvin, W. Scott; Ellison, E. Christopher; Bloomston, Mark.

In: HPB, Vol. 12, No. 2, 03.2010, p. 134-138.

Research output: Contribution to journalArticle

Hatzaras, Ioannis ; Schmidt, Carl ; Muscarella, Peter ; Melvin, W. Scott ; Ellison, E. Christopher ; Bloomston, Mark. / Elevated CA 19-9 portends poor prognosis in patients undergoing resection of biliary malignancies. In: HPB. 2010 ; Vol. 12, No. 2. pp. 134-138.
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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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T1 - Elevated CA 19-9 portends poor prognosis in patients undergoing resection of biliary malignancies

AU - Hatzaras, Ioannis

AU - Schmidt, Carl

AU - Muscarella, Peter

AU - Melvin, W. Scott

AU - Ellison, E. Christopher

AU - Bloomston, Mark

PY - 2010/3

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N2 - 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.

AB - 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.

KW - Cholangiocarcinoma

KW - Gallbladder cancer

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