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Authors: Hahn, Felix
Müller, Lukas
Jungmann, Florian
Mähringer‑Kunz, Aline
Tanyildizi, Yasemin
Düber, Christoph
Galle, Peter R.
Weinmann, Arndt
Kloeckner, Roman
Title: Survival prediction for patients with non-resectable intrahepatic cholangiocarcinoma undergoing chemotherapy : a retrospective analysis comparing the tumor marker CA 19-9 with cross-sectional imaging
Online publication date: 3-May-2021
Language: english
Abstract: PURPOSE Carbohydrate antigen (CA) 19-9 has been established as the main serum marker for patients with intrahepatic cholangiocarcinoma (ICC). The aim of this study was to compare the prognostic value of CA 19-9 changes versus response determined by imaging in patients with ICC undergoing chemotherapy. METHODS Between 2003 and 2018, 151 patients with histopathologically confirmed ICC underwent chemotherapy at our tertiary care center for non-resectable or recurrent ICC, of whom 121 were included in this study. Serum CA 19-9 levels and imaging were retrospectively evaluated during chemotherapy. Log-rank testing and optimal stratification were used to classify patients into risk groups. RESULTS Prior to chemotherapy, baseline serum CA 19-9 levels above the previously published cut-off of 37 U/ml were associated with poor survival (median OS 8.7 vs. 12.4 months, p = 0.003). After the beginning of chemotherapy, an increase in CA 19-9 of more than 40 U/ml resulted in impaired residual survival (median OS 5.0 vs. 12.1 months, p < 0.001). However, progressive disease at the first follow-up imaging proved the strongest predictor for poor outcome (median OS 4.6 vs. 15.5 months, p < 0.001). In contrast to prior studies, our data did not show statistically relevant differences in survival time with respect to absolute or relative decreases in serum CA 19-9 levels. CONCLUSION In our study, the disease control rate—that is, the absence of progressive disease—was the strongest predictor of prolonged residual OS. To this end, both CA 19-9 changes and progressive disease on initial follow-up showed remarkable discriminatory power, with the latter slightly outperforming the former. Therefore, imaging should remain the mainstay of patient evaluation during follow-up.
DDC: 610 Medizin
610 Medical sciences
Institution: Johannes Gutenberg-Universität Mainz
Department: FB 04 Medizin
Place: Mainz
Version: Published version
Publication type: Zeitschriftenaufsatz
Document type specification: Scientific article
License: CC BY
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Journal: Journal of cancer research and clinical oncology
Pages or article number: 1883
Publisher: Springer
Publisher place: Belin u.a.
Issue date: 2020
ISSN: 1432-1335
Publisher URL:
Publisher DOI: 10.1007/s00432-020-03200-2
Appears in collections:JGU-Publikationen

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