The impact of perioperative CA19-9 change on the survival and recurrence patterns after adjuvant chemoradiotherapy in resectable extrahepatic cholangiocarcinoma

Abstract

BackgroundsPerioperative CA19-9 value in pancreato-biliary cancers has been recognized as a prognostic factor. Herein, we investigated survival differences and recurrence patterns after adjuvant chemoradiotherapy by perioperative CA19-9 change in surgically resected extrahepatic cholangiocarcinoma. MethodsPatients were divided into those with preoperative normal CA19-9 (Group 1, n=52), those with high preoperative and normalized postoperative CA19-9 (Group 2, n=80), and those with both high pre- and postoperative CA19-9 (Group 3, n=21). ResultsDepending on the group defined above, the 5-year overall survival (OS) (59.6%, 38.7%, and 9.5%, P<0.001) and disease-free survival (55.8%, 31.2%, and 9.5%, P<0.001) between the three groups differed. On multivariable analysis in patients other than group 1, poor prognosticators for OS were high postoperative CA19-9 (HR 2.26, P=0.008) and N1 disease (HR 2.33, P=0.001). Group 3, compared with group 2, showed higher distant metastasis rate, shorter disease-free interval, and higher CA19-9 at the time of recurrence. ConclusionsSurvival and recurrence patterns after adjuvant chemoradiotherapy are significantly affected by perioperative CA19-9 change. This may have important implications in patient selection for adjuvant chemoradiotherapy and clinical trial design.