Implications of CA19-9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma

A national cohort analysis

John R. Bergquist, Tommy Ivanics, Curtis Storlie, Ryan T. Groeschl, May C. Tee, Elizabeth B Habermann, Rory L. Smoot, Michael L. Kendrick, Michael B. Farnell, Lewis Rowland Roberts, Gregory James Gores, David M. Nagorney, Mark Truty

Research output: Contribution to journalArticle

23 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)475-482
Number of pages8
JournalJournal of Surgical Oncology
Volume114
Issue number4
DOIs
StatePublished - Sep 15 2016

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Cholangiocarcinoma
Cohort Studies
Survival
Therapeutics
Reference Values
Neoplasm Metastasis
Drug Therapy
Mortality
Survival Analysis
Demography
Databases
Radiation

Keywords

  • biologic resectability
  • biomarker
  • CA19-9
  • cholangiocarcinoma

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Implications of CA19-9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma : A national cohort analysis. / Bergquist, John R.; Ivanics, Tommy; Storlie, Curtis; Groeschl, Ryan T.; Tee, May C.; Habermann, Elizabeth B; Smoot, Rory L.; Kendrick, Michael L.; Farnell, Michael B.; Roberts, Lewis Rowland; Gores, Gregory James; Nagorney, David M.; Truty, Mark.

In: Journal of Surgical Oncology, Vol. 114, No. 4, 15.09.2016, p. 475-482.

Research output: Contribution to journalArticle

Bergquist, John R. ; Ivanics, Tommy ; Storlie, Curtis ; Groeschl, Ryan T. ; Tee, May C. ; Habermann, Elizabeth B ; Smoot, Rory L. ; Kendrick, Michael L. ; Farnell, Michael B. ; Roberts, Lewis Rowland ; Gores, Gregory James ; Nagorney, David M. ; Truty, Mark. / Implications of CA19-9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma : A national cohort analysis. In: Journal of Surgical Oncology. 2016 ; Vol. 114, No. 4. pp. 475-482.
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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.",
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T1 - Implications of CA19-9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma

T2 - A national cohort analysis

AU - Bergquist, John R.

AU - Ivanics, Tommy

AU - Storlie, Curtis

AU - Groeschl, Ryan T.

AU - Tee, May C.

AU - Habermann, Elizabeth B

AU - Smoot, Rory L.

AU - Kendrick, Michael L.

AU - Farnell, Michael B.

AU - Roberts, Lewis Rowland

AU - Gores, Gregory James

AU - Nagorney, David M.

AU - Truty, Mark

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N2 - 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.

AB - 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.

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