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World Journal of Surgery

, Volume 42, Issue 10, pp 3331–3340 | Cite as

Surgical Indication for Advanced Intrahepatic Cholangiocarcinoma According to the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value

  • Yusuke Yamamoto
  • Teiichi Sugiura
  • Akiko Todaka
  • Yukiyasu Okamura
  • Takaaki Ito
  • Ryo Ashida
  • Yuko Kakuda
  • Yasuni Nakanuma
  • Katsuhiko Uesaka
Original Scientific Report

Abstract

Background

The indication of surgery in intrahepatic cholangiocarcinoma (ICC) patients with lymph node metastasis (LNM), macroscopic periductal infiltration (PI), and intrahepatic metastasis (IM) remains unclear.

Methods

Patients who underwent resection for mass-forming (MF) dominant ICC and unresected patients caused by LNM, IM, or locally advanced tumors (UR group) were enrolled. The significance of CA19-9 was investigated in advanced ICC.

Results

Seventy-three patients who underwent resection and 20 UR patients were analyzed. Using the minimum p value approach based on the overall survival, the optimal CA19-9 cutoff value was 300 U/mL. The OS of the patients with CA19-9 < 37 U/mL (n = 26; MST, 49.6 months) and 37–300 U/mL (n = 28; MST, 45.1 months) was comparable (P = 0.842); however, the OS of the patients with CA19-9 = 37–300 U/mL was significantly better than that with CA19-9 ≥ 300 U/mL (n = 19; MST, 15.3 months; P < 0.001). CA19-9 > 300 U/mL, MF + PI, and IM were independently associated with OS. The OS of the patients with CA19-9 < 300 U/mL who developed LNM (MST, 34.0 months), MF + PI (MST, 32.9 months), or IM (MST, 35.2 months), or who required major vascular resection (MST, 45.1 months) was better than those with CA19-9 ≥ 300 U/mL who developed LNM (MST, 8.7 months; P = 0.005), MF + PI (MST, 7.5 months; P = 0.040), or IM (MST, 8.7 months; P = 0.001), or who required major vascular resection (MST, 14.8 months; P = 0.015); their prognosis was similar with the UR group.

Conclusions

Even if patients had ICC developing LNM, PI, or IM, or require major vascular resection, surgical resection can be indicated for patients with CA19-9 < 300 U/mL. However, the indications for either adjuvant therapy or resection should be carefully determined in patients with CA19-9 ≥ 300 U/mL.

Abbreviations

ICC

Intrahepatic cholangiocarcinoma

LNM

Lymph node metastasis

IM

Intrahepatic metastasis

VI

Vascular invasion

PI

Periductal infiltrating

EASL

European Association for the Study of Liver

CA19-9

Carbohydrate antigen 19-9

MF

Mass-forming

IG

Intraductal growth

TNM

Tumor-node-metastasis

AJCC

American Joint Committee on Cancer

UICC

International Union Against Cancer

CEA

Carcinoembryonic antigen

PVR

Portal vein resection

HAR

Hepatic artery resection

IVCR

Inferior vena cava resection

Notes

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Yusuke Yamamoto
    • 1
  • Teiichi Sugiura
    • 1
  • Akiko Todaka
    • 2
  • Yukiyasu Okamura
    • 1
  • Takaaki Ito
    • 1
  • Ryo Ashida
    • 1
  • Yuko Kakuda
    • 3
  • Yasuni Nakanuma
    • 3
  • Katsuhiko Uesaka
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic SurgeryShizuoka Cancer CenterSunto-NagaizumiJapan
  2. 2.Division of GI OncologyShizuoka Cancer CenterSunto-NagaizumiJapan
  3. 3.Division of PathologyShizuoka Cancer CenterSunto-NagaizumiJapan

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