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Clinical significance of preoperative CA19-9 and lymph node metastasis in intrahepatic cholangiocarcinoma.
Surg Today. 2020 Oct; 50(10):1176-1186.ST

Abstract

PURPOSE

This study aimed to identify prognostic factors for patients with ICC after a curative resection and clarify the appropriate indications for surgical resection and postoperative adjuvant chemotherapy.

METHODS

This retrospective study included 81 patients who underwent curative resection for ICC between April 1995 and December 2014. Kaplan-Meier and Cox regression models were used to analyze the effects of clinicopathological features on overall and recurrence-free survival.

RESULTS

The cumulative 5-year overall survival of 81 patients was 57.2%, and the 5-year recurrence-free survival was 24.0%. The multivariate analysis identified the lymph node status and preoperative CA19-9 levels as independent prognostic factors for overall survival. The 5-year overall survival rates were 79.9% and 38.7% in patients with normal and elevated CA19-9, respectively (p < 0.0001). The 5-year overall survival rates of patients with and without nodal metastasis were 33.7% and 60.9%, respectively (p = 0.0007). After adjusting for prognostic factors identified in a Cox regression analysis, we found that nodal-positive disease was significantly associated with benefit from adjuvant chemotherapy (HR 0.32, p = 0.03).

CONCLUSIONS

Surgical resection with curative intent combined with regional lymph node dissection should be indicated for ICC patients with normal CA19-9 levels. Postoperative adjuvant chemotherapy should be administered to high-risk patients with a positive nodal status.

Authors+Show Affiliations

Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan. tasaoka@gesurg.med.osaka-u.ac.jp. Department of Surgery, Osaka Police Hospital, Osaka, Japan. tasaoka@gesurg.med.osaka-u.ac.jp.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan. Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan. Department of Surgery, Rinku General Medical Center, Osaka, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32221659

Citation

Asaoka, Tadafumi, et al. "Clinical Significance of Preoperative CA19-9 and Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma." Surgery Today, vol. 50, no. 10, 2020, pp. 1176-1186.
Asaoka T, Kobayashi S, Hanaki T, et al. Clinical significance of preoperative CA19-9 and lymph node metastasis in intrahepatic cholangiocarcinoma. Surg Today. 2020;50(10):1176-1186.
Asaoka, T., Kobayashi, S., Hanaki, T., Iwagami, Y., Tomimaru, Y., Akita, H., Noda, T., Gotoh, K., Takeda, Y., Tanemura, M., Doki, Y., & Eguchi, H. (2020). Clinical significance of preoperative CA19-9 and lymph node metastasis in intrahepatic cholangiocarcinoma. Surgery Today, 50(10), 1176-1186. https://doi.org/10.1007/s00595-020-01992-x
Asaoka T, et al. Clinical Significance of Preoperative CA19-9 and Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma. Surg Today. 2020;50(10):1176-1186. PubMed PMID: 32221659.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical significance of preoperative CA19-9 and lymph node metastasis in intrahepatic cholangiocarcinoma. AU - Asaoka,Tadafumi, AU - Kobayashi,Shogo, AU - Hanaki,Takehiko, AU - Iwagami,Yoshifumi, AU - Tomimaru,Yoshito, AU - Akita,Hirofumi, AU - Noda,Takehiro, AU - Gotoh,Kunihito, AU - Takeda,Yutaka, AU - Tanemura,Masahiro, AU - Doki,Yuichiro, AU - Eguchi,Hidetoshi, Y1 - 2020/03/27/ PY - 2019/12/25/received PY - 2020/03/06/accepted PY - 2020/3/30/pubmed PY - 2020/10/24/medline PY - 2020/3/30/entrez KW - CA19-9 KW - Intrahepatic cholangiocarcinoma KW - Lymph node metastasis SP - 1176 EP - 1186 JF - Surgery today JO - Surg Today VL - 50 IS - 10 N2 - PURPOSE: This study aimed to identify prognostic factors for patients with ICC after a curative resection and clarify the appropriate indications for surgical resection and postoperative adjuvant chemotherapy. METHODS: This retrospective study included 81 patients who underwent curative resection for ICC between April 1995 and December 2014. Kaplan-Meier and Cox regression models were used to analyze the effects of clinicopathological features on overall and recurrence-free survival. RESULTS: The cumulative 5-year overall survival of 81 patients was 57.2%, and the 5-year recurrence-free survival was 24.0%. The multivariate analysis identified the lymph node status and preoperative CA19-9 levels as independent prognostic factors for overall survival. The 5-year overall survival rates were 79.9% and 38.7% in patients with normal and elevated CA19-9, respectively (p < 0.0001). The 5-year overall survival rates of patients with and without nodal metastasis were 33.7% and 60.9%, respectively (p = 0.0007). After adjusting for prognostic factors identified in a Cox regression analysis, we found that nodal-positive disease was significantly associated with benefit from adjuvant chemotherapy (HR 0.32, p = 0.03). CONCLUSIONS: Surgical resection with curative intent combined with regional lymph node dissection should be indicated for ICC patients with normal CA19-9 levels. Postoperative adjuvant chemotherapy should be administered to high-risk patients with a positive nodal status. SN - 1436-2813 UR - https://www.unboundmedicine.com/medline/citation/32221659/Clinical_significance_of_preoperative_CA19_9_and_lymph_node_metastasis_in_intrahepatic_cholangiocarcinoma_ L2 - https://dx.doi.org/10.1007/s00595-020-01992-x DB - PRIME DP - Unbound Medicine ER -