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Clinical significance of preoperative CA19-9 and lymph node metastasis in intrahepatic cholangiocarcinoma

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Abstract

Purpose

This study aimed to identify prognostic factors for patients with ICC after a curative resection and clarify the appropriate indications for surgical resection and postoperative adjuvant chemotherapy.

Methods

This retrospective study included 81 patients who underwent curative resection for ICC between April 1995 and December 2014. Kaplan–Meier and Cox regression models were used to analyze the effects of clinicopathological features on overall and recurrence-free survival.

Results

The cumulative 5-year overall survival of 81 patients was 57.2%, and the 5-year recurrence-free survival was 24.0%. The multivariate analysis identified the lymph node status and preoperative CA19-9 levels as independent prognostic factors for overall survival. The 5-year overall survival rates were 79.9% and 38.7% in patients with normal and elevated CA19-9, respectively (p < 0.0001). The 5-year overall survival rates of patients with and without nodal metastasis were 33.7% and 60.9%, respectively (p = 0.0007). After adjusting for prognostic factors identified in a Cox regression analysis, we found that nodal-positive disease was significantly associated with benefit from adjuvant chemotherapy (HR 0.32, p = 0.03).

Conclusions

Surgical resection with curative intent combined with regional lymph node dissection should be indicated for ICC patients with normal CA19-9 levels. Postoperative adjuvant chemotherapy should be administered to high-risk patients with a positive nodal status.

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Abbreviations

ICC:

Intrahepatic cholangiocarcinoma

CA19-9:

Carbohydrate antigen 19-9

CEA:

Carcinoembryonic antigen

NLR:

Neutrophil-to-lymphocyte ratio

PNI:

Prognostic nutrition index

LN:

Lymph node

LND:

Lymph node dissection

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Tadafumi Asaoka, Shogo Kobayashi, Takehiko Hanaki, Yoshifumi Iwagami, Yoshito Tomimaru, Hirofumi Akita, Takehiro Noda, Kunihito Gotoh, Yutaka Takeda, Masahiro Tanemura, Yuichiro Doki & Hidetoshi Eguchi

  2. Department of Surgery, Osaka Police Hospital, Osaka, Japan

    Tadafumi Asaoka

  3. Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan

    Yutaka Takeda

  4. Department of Surgery, Rinku General Medical Center, Osaka, Japan

    Masahiro Tanemura

Authors
  1. Tadafumi Asaoka
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  2. Shogo Kobayashi
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  3. Takehiko Hanaki
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Correspondence to Tadafumi Asaoka.

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Asaoka, T., Kobayashi, S., Hanaki, T. et al. Clinical significance of preoperative CA19-9 and lymph node metastasis in intrahepatic cholangiocarcinoma. Surg Today 50, 1176–1186 (2020). https://doi.org/10.1007/s00595-020-01992-x

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  • DOI: https://doi.org/10.1007/s00595-020-01992-x

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