@article{277680d2528c4601a87799ffd20614f7,
title = "Implications of CA19-9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma: A national cohort analysis",
abstract = "Background: Optimal management of patients with intrahepatic cholangiocarcinoma (ICCA) and elevated CA19-9 remains undefined. We hypothesized CA19-9 elevation above normal indicates aggressive biology and that inclusion of CA19-9 would improve staging discrimination. Methods: The National Cancer Data Base (NCDB-2010-2012) was reviewed for patients with ICCA and reported CA19-9. Patients were stratified by CA19-9 above/below normal reference range. Unadjusted Kaplan–Meier and adjusted Cox-proportional-hazards analysis of overall survival (OS) were performed. Results: A total of 2,816 patients were included: 938 (33.3%) normal; 1,878 (66.7%) elevated CA19-9 levels. Demographic/pathologic and chemotherapy/radiation were similar between groups, but patients with elevated CA19-9 had more nodal metastases and less likely to undergo resection. Among elevated-CA19-9 patients, stage-specific survival was decreased in all stages. Resected patients with CA19-9 elevation had similar peri-operative outcomes but decreased long-term survival. In adjusted analysis, CA19-9 elevation independently predicted increased mortality with impact similar to node-positivity, positive-margin resection, and non-receipt of chemotherapy. Proposed staging system including CA19-9 improved survival discrimination over AJCC 7th edition. Conclusion: Elevated CA19-9 is an independent risk factor for mortality in ICCA similar in impact to nodal metastases and positive resection margins. Inclusion of CA19-9 in a proposed staging system increases discrimination. Multi-disciplinary therapy should be considered in patients with ICCA and CA19-9 elevation. J. Surg. Oncol. 2016;114:475–482.",
keywords = "CA19-9, biologic resectability, biomarker, cholangiocarcinoma",
author = "Bergquist, {John R.} and Tommy Ivanics and Storlie, {Curtis B.} and Groeschl, {Ryan T.} and Tee, {May C.} and Habermann, {Elizabeth B.} and Smoot, {Rory L.} and Kendrick, {Michael L.} and Farnell, {Michael B.} and Roberts, {Lewis R.} and Gores, {Gregory J.} and Nagorney, {David M.} and Truty, {Mark J.}",
note = "Funding Information: The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used are derived from a de-identified NCDB participant user file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methods or the conclusions drawn from these data by the investigators. The authors gratefully acknowledge the support of the Mayo Clinic Department of Surgery and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery as substantial contributors of resources to the project. Additionally, Dr. Bergquist acknowledges the support of the Mayo Clinic Clinician Investigator Training Program for salary support. Finally, we would like to thank the Society of Surgical Oncology for affording us the opportunity to present this work at their annual Cancer Symposium in March 2016. The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery provides salary support for Dr. Habermann, Dr. Storlie, and Dr. Ivanics. Dr. Bergquist receives salary support from the Mayo Clinic Clinician Investigator Training program. Dr. Gores is supported by NIH R01 DK059427, DK041876, and DK063947. Dr. Roberts is supported by NIH R01 CA165076 and U01 DK082843. The conduct and presentation of this research was independent of the above funding sources. This work has not previously or concurrently been submitted for publication. The work was presented during the Society of Surgical Oncology Annual Cancer Symposium, Boston, MA March 2–5, 2016. Publisher Copyright: {\textcopyright} 2016 Wiley Periodicals, Inc.",
year = "2016",
month = sep,
day = "15",
doi = "10.1002/jso.24381",
language = "English (US)",
volume = "114",
pages = "475--482",
journal = "Journal of Surgical Oncology",
issn = "0022-4790",
publisher = "Wiley-Liss Inc.",
number = "4",
}