Preoperative total bile acid can be used as a prognostic biomarker in patients with operable biliary tract cancers

Biliary tract cancers (BTCs) are highly invasive malignancies with poor prognoses. However, reliable biomarkers for survival prediction remain lacking. Notably, abnormal lipid metabolism has elicited increasing interest in digestive tract tumors, with the liver playing an important role in lipid metabolism.

To explore the relationship between hepatic lipid metabolism-related indicators, assessed through routine clinical biochemical testing and survival prognosis in patients with BTCs.

Overall, 109 patients with a pathological diagnosis of BTC from 2017 to 2023 were included in this study. Univariate and multivariate Cox regression analyses were performed using R Studio software, and survival curves were plotted.

Univariate analysis revealed that tumor location and preoperative total bile acid (TBA), carcinoembryonic antigen, cancer antigen (CA)125, and CA19-9 levels were correlated with patient survival (P < 0.05). Multivariate Cox regression analysis identified increased TBA level [hazard ratio (HR) = 0.445, P = 0.004] as an independent prognostic factor for longer survival. Conversely, tumor location [intrahepatic cholangiocarcinoma (iCCA) and/or extrahepatic cholangiocarcinoma (eCCA)] (HR = 2.463, P = 0.036) and increased CA125 and CA19-9 levels (HR = 2.549, P = 0.008 and HR = 2.100, P = 0.019) were independent prognostic factors for shorter survival. Additionally, Kaplan‒Meier survival curves revealed significantly longer survival in patients with increased TBA levels than those in the normal group (P = 0.012). Conversely, patients with iCCA and/or eCCA tumor location and increased CA125 and CA19-9 levels had significantly shorter median survival (P = 0.044, P = 0.013, and P = 0.012, respectively).

TBA may be a biomarker for predicting survival in patients with operable BTC, highlighting its clinical significance and application potential.