Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2021; 13(9): 1025-1038
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.1025
Carbohydrate antigen 19-9 as a novel prognostic biomarker in distal cholangiocarcinoma
Tao Jiang, Shao-Cheng Lyu, Lin Zhou, Jing Wang, Han Li, Qiang He, Ren Lang
Tao Jiang, Shao-Cheng Lyu, Lin Zhou, Jing Wang, Han Li, Qiang He, Ren Lang, Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Author contributions: Jiang T and Lyu SC contributed to the conception and design; He Q and Lang R contributed to the administrative support; Zhou L and Lang R contributed to the provision of study materials or patients; Wang J and Li H contributed to the collection and assembly of data; Lyu SC, Wang J and Zhou L contributed to the data analysis and interpretation; All authors contributed to the manuscript writing and final approval of manuscript.
Supported by the Beijing Municipal Science & Technology Commission, No. Z181100001718164; and Capital’s Funds for Health Improvement and Research, No. CFH 2020-2-2036.
Institutional review board statement: The study was approved by the Ethics Committee of Beijing Chaoyang Hospital, No. 2020-D.-301.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ren Lang, MD, PhD, Academic Fellow, Chief Doctor, Professor, Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing 100020, China. dr_langren@126.com
Received: March 1, 2021
Peer-review started: March 1, 2021
First decision: June 3, 2021
Revised: June 18, 2021
Accepted: August 19, 2021
Article in press: August 19, 2021
Published online: September 27, 2021
Abstract
BACKGROUND

Distal cholangiocarcinoma (DCC) presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis. Curative resection is currently the most appropriate therapy for patients with DCC because of the lack of effective adjuvant therapies. Therefore, it is important to accurately predict the prognosis for formulating a reasonable treatment plan and avoiding unnecessary surgical trauma.

AIM

To minimize the interference of obstructive jaundice on carbohydrate antigen 19-9 (CA19-9) level by adapting CA19-9 to γ-glutamyltransferase (GGT) as an indicator, to determine the strong associations between CA19-9/GGT and postoperative neoplasm recurrence and long-term outcome of DCC.

METHODS

We enrolled 186 patients who were diagnosed with DCC between January 2010 and December 2019 and performed radical excision with strict criteria as follows in our hospital. Receiver operating characteristic curves were drawn according to preoperative CA19-9/GGT and 1-year survival. Based on this, patients were divided into two groups (group 1, low-ratio, n = 81; group 2, high-ratio, n = 105). Afterwards, by the way of univariate and multivariate analysis, the risk factors influencing postoperative tumor recrudesce and long-term prognosis of patients with DCC were screened out.

RESULTS

Optimum cut-off value of CA19-9/GGT was 0.12. Patients in group 2 represented higher CA19-9 and lymphatic metastasis rate accompanied by lower GGT, when compared with group 1 (P < 0.05). The 1-, 3- and 5-year overall survival rates of patients in groups 1 and 2 were 88.3%, 59.2% and 48.1%, and 61.0%, 13.6% and 13.6%, respectively (P = 0.000). Multivariate analysis indicated that CA19-9/GGT, lymphatic metastasis and tumor differentiation were independent risk factors for tumor recurrence and long-term prognosis of DCC.

CONCLUSION

Elevation of CA19-9/GGT performed better as a biomarker of aggressive carcinoma and predictor of poor clinical outcomes by reducing the effect of obstruction of biliary tract on CA19-9 concentration in patients with DCC.

Keywords: Distal cholangiocarcinoma, Pancreaticoduodenectomy, Carbohydrate antigen 19-9, γ-Glutamyltransferase, Relapse, Prognosis

Core Tip: Distal cholangiocarcinoma (DCC) is a rare malignant tumor in the digestive system and has a poor long-term prognosis. Curative resection is currently the best treatment for patients with DCC because of the lack of effective adjuvant therapies. Therefore, it is important to accurately predict the prognosis for formulating a reasonable treatment plan and avoiding unnecessary surgical trauma. Carbohydrate antigen 19-9 to serum γ-glutamyltransferase (CA19-9/GGT) ratio was adapted as an indicator to minimize the interference of obstructive jaundice CA19-9 level, to determine the strong associations between CA19-9/GGT and postoperative neoplasm recurrence and long-term outcome of DCC.