Combined Tumor Burden Score and Carbohydrate Antigen 19-9 Grading System to Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma-Reference-Cited by-同舟云学术

Combined Tumor Burden Score and Carbohydrate Antigen 19-9 Grading System to Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma

Published:2023-01-12 Issue:4 Volume:236 Page:804-813
ISSN:1072-7515
Container-title:Journal of the American College of Surgeons
language:en
Short-container-title:

Author:

Moazzam Zorays¹,Alaimo Laura¹,Endo Yutaka¹,Lima Henrique A¹,Ruzzenente Andrea²,Guglielmi Alfredo²,Aldrighetti Luca³,Weiss Matthew⁴,Bauer Todd W⁵,Alexandrescu Sorin⁶,Poultsides George A⁷,Maithel Shishir K⁸,Marques Hugo P⁹,Martel Guillaume¹⁰,Pulitano Carlo¹¹,Shen Feng¹²,Cauchy François¹³,Koerkamp Bas Groot¹⁴,Endo Itaru¹¹⁵,Cloyd Jordan¹,Ejaz Aslam¹,Pawlik Timothy M¹

Affiliation:

1. From the Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Moazzam, Alaimo, Endo, Lima, Cloyd, Ejaz, Pawlik)

2. Department of Surgery, University of Verona, Verona, Italy (Ruzzenente, Guglielmi)

3. Department of Surgery, Ospedale San Raffaele, Milan, Italy (Aldrighetti)

4. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD (Weiss)

5. Department of Surgery, University of Virginia, Charlottesville, VA (Bauer)

6. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania (Alexandrescu)

7. Department of Surgery, Stanford University, Stanford, CA (Poultsides)

8. Department of Surgery, Emory University, Atlanta, GA (Maithel)

9. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (Marques)

10. Department of Surgery, University of Ottawa, Ottawa, ON, Canada (Martel)

11. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia (Pulitano)

12. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China (Shen)

13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France (Cauchy)

14. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (Koerkamp)

15. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan (Endo).

Abstract

BACKGROUND:The interplay of carbohydrate antigen 19-9 (CA19-9) and tumor burden score (TBS) within intrahepatic cholangiocarcinoma remains ill-defined. We evaluated the roles of TBS and CA19-9 relative to overall survival (OS) and recurrence, as well as the predictive ability of the combined TBS and CA19-9 (CTC) grading system.STUDY DESIGN:Patients undergoing liver resection for intrahepatic cholangiocarcinoma between 2000 and 2020 were identified using a multi-institutional database. The impact of CA19-9 and TBS on 5-year OS and 3-year recurrence was assessed, along with the prognostic accuracy of the CTC grading system (ie the composite score of CA19-9 level and TBS).RESULTS:Among 831 patients, the median age was 58.2 years and 482 (58.0%) were male. The median [IQR] CA19-9 level was 49.7 [17.0, 221.0] U/mL and TBS was 6.1 [4.1, 8.3]. Median [IQR] and 5-year OS were 36.9 [32.3, 43.1] months and 38.9%, respectively; 3-year recurrence was 68.9%. Five-year survival varied relative to CA19-9 (low vs high, 49.0% vs 19.7%) and TBS (low vs high, 53.6% vs 26.9%) (p < 0.001 for both). On multivariable analysis, high CA19-9 (hazard ratio [HR] 2.02, 95% CI 1.64 to 2.49) and high TBS (HR 1.64, 95% CI 1.32 to 2.06) remained independently associated with OS. In turn, the CTC grading score stratified 5-year OS (low vs intermediate vs high CTC, 57.7% vs 39.9% vs 12.6%; p < 0.001) and remained an independent prognostic factor (referent, low CTC; [intermediate CTC] HR 1.54, 95% CI 1.18 to 2.01; [high CTC] HR 3.28, 95% CI 2.47 to 4.36).CONCLUSIONS:The interplay between tumor morphology and biology dictates long-term prognosis after liver resection for intrahepatic cholangiocarcinoma. Prognostic models such as the CTC grading system may inform discussions around prognosis, as well as help identify which patients with ICC may benefit more from neoadjuvant chemotherapy rather than up-front surgery.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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