Abstract

BACKGROUND: The interplay of CA19-9 and tumor burden score (TBS) in intrahepatic cholangiocarcinoma (ICC) remains ill-defined. We evaluated the role of TBS and CA19-9 relative to overall survival (OS) and recurrence, as well as the predictive ability of the Combination of TBS and CA 19-9 (CTC) grading system.STUDY DESIGN: Patients who underwent liver resection for ICC between 2000-2020 were identified using a multi-institutional database. The impact of CA19-9 and TBS on 5-year OS and 3-year recurrence was assessed, along with the prognostic accuracy of the CTC system (a composite score of CA19-9 and TBS).RESULTS: Among 831 patients, the median age was 58.2 years and 482 (58.0%) were male. The median CA19-9 level was 49.7 (17.0-221.0) U/mL, while median TBS was 6.1 (IQR 4.1-8.3). Median and 5-year OS were 36.9 (IQR 32.3-43.1) months and 38.9%, respectively; overall 3-year recurrence was 68.9%. Survival varied relative to CA19-9 (low: 49.0% vs. high: 19.7%) and TBS (low: 53.6% vs. high: 26.9%) had worse 5-year survival (both p<0.001). On multivariable analysis, high CA19-9 (HR 2.02, 95%CI 1.64-2.49) and high TBS (HR1.64, 95%CI 1.32-2.06) remained independently associated with OS. In turn, the CTC grading score stratified 5-year OS (low CTC: 57.7% vs. intermediate CTC: 39.9% vs. high CTC: 12.6%; p<0.001), and remained an independent prognostic factor (referent: low CTC; intermediate CTC HR 1.54, 95%CI 1.18-2.01; high CTC: HR 3.28, 95%CI 2.47-4.36).CONCLUSION: The interplay between tumor morphology and biology dictated long-term prognosis after liver resection for ICC. Prognostic models such as the CTC grading system may inform discussions around prognosis, as well as help identify which patients with ICC may benefit more from neoadjuvant chemotherapy rather than up-front surgery.

View details for DOI 10.1097/XCS.0000000000000557

View details for PubMedID 36728327