Implications of CA19‐9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma: A national cohort analysis. Issue 4 (20th July 2016) - Bergquist, John R.
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 . © 2016 Wiley Periodicals, Inc.