CEA but not CA19 – 9 is an independent prognostic factor in patients undergoing resection of cholangiocarcinoma

Question:

Cholangiocarcinoma (CCA) represents a rare form of liver cancer with increasing incidence but dismal prognosis. Surgical treatment has remained the only potentially curative treatment option, but it is still unclear which patients benefit most from liver surgery. In clinical routine, CA19 – 9 represents the most widely used tumor marker in the diagnostic workup of CCA patients. However, data on the prognostic value of CA19 – 9 are limited and often inconclusive, mostly due to small cohort sizes in this rare tumor type. Here, we investigated the prognostic value of CA19 – 9 in comparison with other laboratory markers in a large cohort of CCA patients that underwent tumor resection.

Methods:

A total of 190 CCA patients as well as 50 healthy controls and 24 patients with primary sclerosing cholangitis (PSC) were included into this study. Serum levels of tumor markers and other laboratory markers were measured and correlated with clinical data.

Results:

While both tumor markers CA19 – 9 and CEA were able to discriminate between CCA and healthy controls, CEA showed a higher accuracy for the differentiation between CCA and patients with PSC compared to CA19 – 9. Furthermore, patients with elevated levels of C-reactive protein, CA19 – 9 or CEA showed a significantly impaired survival, but surprisingly, only CEA but not CA19 – 9 represented an independent predictor of survival in multivariate Cox-regression analysis.

Conclusions:

Our data suggest that CEA – which in CCA patients is less frequently assessed than CA19 – 9 in clinical routine – might help to identify CCA patients with an unfavorable prognosis after tumor resection.