Kazunari Sasaki1, Georgios A Margonis2, Nikolaos Andreatos2, Qinyu Chen3, Carlotta Barbon2, Fabio Bagante4, Matthew Weiss2, Irinel Popescu5, Hugo P Marques6, Luca Aldrighetti7, Shishir K Maithel8, Carlo Pulitano9, Todd W Bauer10, Feng Shen11, George A Poultsides12, Olivier Soubrane13, Guillaume Martel14, Bas Groot Koerkamp15, Alfredo Guglielmi4, Itaru Endo16, Federico N Aucejo1, Timothy M Pawlik17. 1. Department of Surgery, Cleveland Clinic, Cleveland, OH, USA. 2. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 3. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 4. Department of Surgery, University of Verona, Verona, Italy. 5. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 6. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 7. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 8. Department of Surgery, Emory University, Atlanta, GA, USA. 9. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 10. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 11. Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 12. Department of Surgery, Stanford University, Stanford, CA, USA. 13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France. 14. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada. 15. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. 16. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan. 17. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: tim.pawlik@osumc.edu.
Abstract
BACKGROUND: While several prognostic models have been developed to predict long-term outcomes in resectable intrahepatic cholangiocarcinoma (ICC), their prognostic discrimination remains limited. The addition of tumor markers might improve the prognostic power of the classification schemas proposed by the AJCC 8th edition and the Liver Cancer Study Group of Japan (LCSGJ). METHODS: The prognostic discrimination of the AJCC and the LCSGJ were compared before and after the addition of CA 19-9 and CEA, using Harrell's C-index, net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) in an international, multi-institutional cohort. RESULTS: Eight hundred and five surgically treated patients with ICC that met the inclusion criteria were identified. On multivariable analysis, CEA5 ng/mL, 100IU/mL CA 19-9< 500IU/mL and CA 19-9500 IU/mL were associated with worse overall survival. The C-index of the AJCC and the LCSGJ improved from 0.540 to 0.626 and 0.553 to 0.626, respectively following incorporation of CA 19-9 and CEA. The NRI and IDI metrics confirmed the superiority of the modified AJCC and LCSGJ, compared to the original versions. CONCLUSION: The inclusion of preoperative CA 19-9 and CEA in the AJCC and LCSGJ staging schemas may improve prognostic discrimination among surgically treated patients with ICC.
BACKGROUND: While several prognostic models have been developed to predict long-term outcomes in resectable intrahepatic cholangiocarcinoma (ICC), their prognostic discrimination remains limited. The addition of tumor markers might improve the prognostic power of the classification schemas proposed by the AJCC 8th edition and the Liver Cancer Study Group of Japan (LCSGJ). METHODS: The prognostic discrimination of the AJCC and the LCSGJ were compared before and after the addition of CA 19-9 and CEA, using Harrell's C-index, net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) in an international, multi-institutional cohort. RESULTS: Eight hundred and five surgically treated patients with ICC that met the inclusion criteria were identified. On multivariable analysis, CEA5 ng/mL, 100IU/mL CA 19-9< 500IU/mL and CA 19-9500 IU/mL were associated with worse overall survival. The C-index of the AJCC and the LCSGJ improved from 0.540 to 0.626 and 0.553 to 0.626, respectively following incorporation of CA 19-9 and CEA. The NRI and IDI metrics confirmed the superiority of the modified AJCC and LCSGJ, compared to the original versions. CONCLUSION: The inclusion of preoperative CA 19-9 and CEA in the AJCC and LCSGJ staging schemas may improve prognostic discrimination among surgically treated patients with ICC.
Authors: Amika Moro; Rittal Mehta; Kota Sahara; Diamantis I Tsilimigras; Anghela Z Paredes; Ayesha Farooq; J Madison Hyer; Itaru Endo; Feng Shen; Alfredo Guglielmi; Luca Aldrighetti; Matthew Weiss; Todd W Bauer; Sorin Alexandrescu; George A Poultsides; Shishir K Maithel; Hugo P Marques; Guillaume Martel; Carlo Pulitano; Olivier Soubrane; Bas G Koerkamp; Kazunari Sasaki; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2020-03-20 Impact factor: 5.344