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
ARTICLE HIGHLIGHTS
Research background

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

Research motivation

At present, tumor differentiation, lymphatic metastasis and other pathological risk factors for DCC can only be obtained after surgery, and the information acquisition is delayed.

Research objectives

We aimed to minimize the interference effect of obstructive jaundice on the concentration of carbohydrate antigen 19-9 (CA19-9), so as to determine the strong association between CA19-9/γ-glutamyltransferase (GGT) and postoperative tumor recurrence and long-term outcome of DCC.

Research methods

We enrolled 186 patients. Receiver operating characteristic curves were drawn according to preoperative CA19-9/GGT and 1-year survival, and the patients were divided into two groups (group 1, low-ratio, n = 81; group 2, high-ratio, n = 105). By univariate and multivariate analyses, the risk factors influencing tumor recurrence and long-term outcome of patients with DCC were screened out.

Research results

The optimum value of CA19-9/GGT was 0.12. Patients in group 2 had 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 group 1 and group 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.

Research conclusions

Elevation of CA19-9/GGT performed better as an indicator of aggressive tumor behavior, as well as a predictor of poor clinical outcomes by reducing the effect of biliary obstruction on CA19-9 concentration in patients with DCC. CA19-9/GGT might be a significant indicator for identifying DCC patients at high risk of early recurrence and unfavorable prognosis.

Research perspectives

CA19-9/GGT is more valuable in judging DCC patients at high risk of early recurrence and unfavorable outcomes.