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Prediction of Prognosis for cHCC-CC Patients After Surgery: Comparison of Tumor Marker Score Based on AFP, CEA, CA19-9, and Other Clinical Stages

Annals of Surgical Oncology volume 28, pages 7647–7660 (2021)Cite this article

Abstract

Background

The effectiveness of clinical stage as a prognostic factor in combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) patients is controversial.

Patients and Methods

Medical records of all pathologically confirmed cHCC-CC patients from 2000 to 2017 at West China Hospital were retrieved. Tumor marker score (TMS) was determined from optimal AFP, CEA, and CA19-9 cutoff values. Interaction and subgroup analysis were conducted according to potential confounders. Prognostic value of TMS and other prognostic models were evaluated by Kaplan–Meier (K–M) analysis, c-index, and time-dependent receiver operating curves (td-ROC).

Results

Optimal cutoff values for preoperative AFP, CEA, and CA19-9 were 10.76 ng/mL, 5.24 ng/mL, and 31.54 U/mL, respectively. Among 128 patients, 24, 58, and 46 were classified into TMS 0, TMS 1, and TMS ≥ 2, respectively. TMS could stratify our series into groups of statistically different prognosis. Subgroup analysis according to potential confounders and test for interactions showed that TMS 1 and TMS ≥ 2 were stable risk factors relative to TMS 0. Univariate (HR: TMS1 = 2.30, p = 0.014; TMS ≥ 2 = 5.1, p < 0.001) and multivariate Cox regression analyses (HR: TMS1 = 1.72, p = 0.124; TMS ≥ 2 = 4.15, p < 0.001) identified TMS as an independent prognostic risk factor. TMS had good discrimination (c-index 0.666, 95% CI 0.619–0.714), and calibration plots revealed favorable consistency. Area under the curve (AUC) value of td-ROC for TMS and integrated AUC was higher than for other clinical stages at any month within 5 years postoperation.

Conclusion

TMS exhibited optimal prognostic value over other widely used clinical stages for cHCC-CC after surgery and may guide clinicians in prognostic prediction.

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Data Availability

All data included in this study are available upon request by contact with the corresponding author.

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Acknowledgment

This work was supported by grants from the National Key Technologies R&D Program (2018YFC1106800), the Natural Science Foundation of China (81972747, 81872004, 81800564, 81770615, 81700555, and 81672882), the Science and Technology Support Program of Sichuan Province (2019YFQ0001, 2018SZ0115, and 2017SZ0003), the Science and Technology Program of Tibet Autonomous Region (XZ201801-GB-02), and the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYJC18008).

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  1. Gui-Min Hou and Hai-ling Liu have contributed equally to this work.

Affiliations

  1. Department of Liver Surgery and Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Gui-Min Hou MD, Hai-ling Liu MD, Hong Wu MD & Yong Zeng MD

  2. Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China

    Gui-Min Hou MD, Hai-ling Liu MD, Hong Wu MD & Yong Zeng MD

  3. Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan Province, China

    Gui-Min Hou MD, Hai-ling Liu MD & Yong Zeng MD

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Correspondence to Yong Zeng MD.

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Hou, GM., Liu, Hl., Wu, H. et al. Prediction of Prognosis for cHCC-CC Patients After Surgery: Comparison of Tumor Marker Score Based on AFP, CEA, CA19-9, and Other Clinical Stages. Ann Surg Oncol 28, 7647–7660 (2021). https://doi.org/10.1245/s10434-021-09949-1

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