Value of preoperative and postoperative carbohydrate antigen 19-9 levels in predicting prognosis and early recurrence in patients with hilar cholangiocarcinoma

Objective To investigate the value of preoperative and postoperative carbohydrate antigen 19-9 ( CA19-9) levels in predicting the prognosis and early recurrence of patients with hilar cholangiocarcinoma ( HCCA) . Methods A total of 80 patients with HCCA who underwent radical resection in The Second Affiliated Hospital of Shaanxi University of Chinese Medicine from January 2001 to December2013 were enrolled. According to their medical records and examination results, the clinical data including age and sex were recorded. Electrochemical luminescence was used to measure the serum level of CA19-9. The cut-off points of preoperative and postoperative CA19-9 levels in predicting the survival rate of HCCA patients were divided into ≤100 U/ml and > 100 U/ml groups, ≤150 U/ml and > 150 U/ml groups, ≤200 U/ml and > 200 U/ml groups, and ≤400 U/ml and > 400 U/ml groups. The Kaplan-Meier method was used to compare the survival rate between CA19-9 ≤150 U/ml group and CA19-9 > 150 U/ml group, as well as between increased CA19-9 group, ≤50% reduction in CA19-9 group, and > 50% reduction in CA19-9 group. Univariate and multivariate non-conditional logistic regression analyses were used to analyze the association of preoperative and postoperative CA19-9 levels with clinical data. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results There was a significant difference in the prediction of survival time of HCCA patients undergoing radical resection between the cut-off points of preoperative CA19-9 of 100, 150, 200, and 400 U/ml ( t = 2. 85, 3. 66, 2. 84, and 2. 55, P < 0. 05) , as well as between the cut-off points of postoperative CA19-9 of 100, 150, 200, and 400 U/ml ( t = 3. 06, 4. 55, 3. 08, and 5. 15, P < 0. 05) . The Kaplan-Meier survival analysis showed that the HCCA patients undergoing radical resection with a preoperative CA19-9 level of ≤150 U/ml had a significantly higher survival rate than those with a preoperative CA19-9 level of > 150 U/ml ( P < 0. 05) ; the HCCA patients undergoing radical resection with a postoperative CA19-9 level of ≤150 U/ml had a significantly higher survival rate than those with a postoperative CA19-9 level of > 150 U/ml ( P < 0. 05) . The HCCA patients who underwent radical resection and had an increase in CA19-9 after surgery had a significantly higher survival rate than those who had a ≤50% or > 50% reduction in CA19-9 after surgery ( both P < 0. 05) .The univariate and multivariate analyses showed that in HCCA patients undergoing radical resection, the preoperative CA19-9 level was associated with lymph node metastasis and early recurrence ( both P < 0. 05) and the postoperative CA19-9 level was associated with early recurrence ( P < 0. 05) . Conclusion Preoperative and postoperative CA19-9 levels can be used to predict survival and early recurrence of patients with resectable HCCA. An increase in CA19-9 level after surgery may cause early recurrence and poor survival outcome in patients with HCCA.