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Does CA 19-9 Have Prognostic Relevance in Gallbladder Carcinoma (GBC)?
Sushma Agrawal1, Able Lawrence2, Rajan Saxena3
1Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India. sushmaagrawal@yahoo.co.uk.
Journal of Gastrointestinal Cancer
|January 21, 2017
Summary
Carbohydrate antigen (CA 19-9) levels correlate with gallbladder carcinoma (GBC) burden and can aid prognostication, especially after extended cholecystectomy (EC). Levels above 20 units/ml after EC and 35 units/ml in other groups may indicate poorer outcomes.
Area of Science:
- Oncology
- Biomarkers
- Surgical Oncology
Background:
- Limited data exists on the prognostic significance of carbohydrate antigen (CA 19-9) in gallbladder carcinoma (GBC).
- This study aimed to assess the prognostic relevance of CA 19-9 across various GBC prognostic subsets.
Purpose of the Study:
- To evaluate the prognostic relevance of carbohydrate antigen (CA 19-9) in different prognostic subsets of gallbladder carcinoma (GBC).
- To determine the correlation between baseline CA 19-9 levels and disease burden.
- To assess the predictive performance of CA 19-9 for overall survival (OS).
Main Methods:
- A retrospective analysis of 141 GBC patients treated between January 2012 and December 2014.
- Baseline CA 19-9 levels were analyzed in four cohorts: extended cholecystectomy (EC), simple cholecystectomy (SC) with residual/recurrent disease, locally advanced GBC (LAGBC), and metastatic disease.
- Clinicopathological variables, treatment-related factors, and CA 19-9 levels were evaluated for their impact on overall survival (OS), with AUC curve analysis performed.
Main Results:
- Median baseline CA 19-9 levels significantly differed across prognostic groups (10 units/ml in EC, 24 in SC, 48 in LAGBC, 75 in metastatic disease; p<0.001).
- Median OS also varied significantly (24 months in EC, 15 in SC, 7 in LAGBC, 6 in metastatic disease; p<0.001).
- Univariate analysis showed CA 19-9 levels (log-transformed, <20 or >35 units) and treatment modalities influenced OS. Multivariate analysis identified treatment-related variables as significant (HR 1.1, p=0.009). AUC was 0.63 overall and 0.72 for EC.
Conclusions:
- Baseline CA 19-9 levels effectively predict the extent of gallbladder carcinoma (GBC) disease.
- Serum CA 19-9 levels exceeding 20 units/ml are recommended for prognostication post-extended cholecystectomy (EC).
- Levels above 35 units/ml show a trend for prognostication in other GBC groups, warranting further investigation in larger cohorts.
