&lt;p&gt;Preoperative Bilirubin-Adjusted Carbohydrate Antigen 19-9 as a Prognostic Factor for Extrahepatic Cholangiocarcinoma Patients at a Single Center&lt;/p&gt;

Li, Jiayi; Qiao, Chen; Bao, Ji; Shi, Yue; Wu, Xiangan; Xu, Haifeng; Zheng, Yongchang; Wang, Yingyi; Du, Shunda; Lü, Xin; Mao, Yilei; Sang, Xinting

doi:10.2147/cmar.s229329

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…The pathophysiological explanation for this could be that the biliary tract functions as an excretion pathway for CA19-9 to the liver and, therefore, an obstruction causing hyperbilirubinemia could block the bile flow, resulting in higher serum levels of CA19-9 [ 28 ]. In the light of this hypothesis, studies suggest that adjusting CA19-9 to bilirubin by calculating the CA19-9/bilirubin ratio could have a stronger diagnostic value than CA19-9 alone [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Value of the CA19-9 and Bilirubin Ratio in Patients with Pancreatic Cancer, Distal Bile Duct Cancer and Benign Periampullary Diseases, a Novel Approach

Boyd

Ali

Kam

et al. 2022

Cancers

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Distinction of pancreatic ductal adenocarcinoma (PDAC) in the head of the pancreas, distal cholangiocarcinoma (dCCA), and benign periampullary conditions, is complex as they often share similar clinical symptoms. However, these diseases require specific management strategies, urging improvement of non-invasive tools for accurate diagnosis. Recent evidence has shown that the ratio between CA19-9 and bilirubin levels supports diagnostic distinction of benign or malignant hepatopancreaticobiliary diseases. Here, we investigate the diagnostic value of this ratio in PDAC, dCCA and benign diseases of the periampullary region in a novel fashion. To address this aim, we enrolled 265 patients with hepatopancreaticobiliary diseases and constructed four logistic regression models on a subset of patients (n = 232) based on CA19-9, bilirubin and the ratio of both values: CA19-9/(bilirubin−1). Non-linearity was investigated using restricted cubic splines and a final model, the ‘Model Ratio’, based on these three variables was fitted using multivariable fractional polynomials. The performance of this model was consistently superior in terms of discrimination and calibration compared to models based on CA19-9 combined with bilirubin and CA19-9 or bilirubin alone. The ‘Model Ratio’ accurately distinguished between malignant and benign disease (AUC [95% CI], 0.91 [0.86–0.95]), PDAC and benign disease (AUC 0.91 [0.87–0.96]) and PDAC and dCCA (AUC 0.83 [0.74–0.92]) which was confirmed by internal validation using 1000 bootstrap replicates. These findings provide a foundation to improve minimally-invasive diagnostic procedures, ultimately ameliorating effective therapy for PDAC and dCCA.

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Section: Introductionmentioning

confidence: 99%

The Diagnostic Value of the CA19-9 and Bilirubin Ratio in Patients with Pancreatic Cancer, Distal Bile Duct Cancer and Benign Periampullary Diseases, a Novel Approach

Boyd

Ali

Kam

et al. 2022

Cancers

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Retrospective study of preoperative CA199 combined control nutritional status score to predict the prognosis of distal cholangiocarcinoma

Liu,

Li,

et al. 2024

Preprint

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Distal cholangiocarcinoma (dCCA) can be independently predicted by the Control of Nutritional Status (CONUT) score and CA199 levels. The purpose of this study was to evaluate the ability of the CONUT score and CA199 to predict surgical outcomes in patients with dCCA in combination with CA199. An examination of preoperative CONUT scores and serum CA199 levels was conducted retrospectively. The patients were categorized into four groups according to their preoperative CONUT scores and serum CA199 concentrations. The examination of the differences between overall survival (OS) and recurrence-free survival (RFS) was also conducted among different groups of patients.The preoperative CONUT-CA199 score is a prognostic factor that can independently forecast the results for surgical distal bile duct carcinoma patients. In the Cox multivariate regression analysis, lymph node metastasis positivity, decreased serum albumin (ALB), elevated CA199, elevated CONUT, and elevated significant unfavorable prognostic markers for distal bile duct carcinoma were discovered to be CA199-CONUT scores. Meanwhile, in the ROC curve analysis, compared to preoperative CA199 and preoperative CONUT scores separately, the combined preoperative CONUT-CA199 score exhibited a higher Area Under the Curve (AUC) value.Compared to any single factor, it provided more accurate prognostic information for postoperative distal bile duct cancer patients.Moreover, patients' OS and RFS are negatively correlated with their preoperative CONUT-CA199 score.Patients with postoperative distal bile duct carcinoma can be independently predicted by their preoperative CONUT-CA199 score, and patients with distal bile duct carcinoma may have a better postoperative outcome when their CONUT-CA199 scores are classified.

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Preoperative Alkaline Phosphatase-adjusted CA19-9 as a Superior Prognosticator for Extrahepatic Biliary Tract Cancer With Jaundice

Ikuta¹,

Aihara²,

Nakajima³

et al. 2022

CDP

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Background/Aim: The major limitation of carbohydrate antigen (CA)19-9 as a tumor marker is the high incidence of false-positive results during cholestasis. We evaluated preoperative CA19-9 and its adjusted values [ratios of CA19-9 to total-bilirubin (TB), direct-bilirubin (DB), and alkaline phosphatase (ALP)] to investigate the most suitable prognostic parameter in extrahepatic biliary tract cancer (eBTC) patients with or without jaundice. Patients and Methods: eBTC patients (n=140) who underwent resection were divided based on the absence (TB <2.0 mg/dl, n=90) or presence (TB ≥2.0 mg/dl, n=50) of preoperative jaundice. Within each group, the associations with overall survival (OS) were assessed for CA19-9, CA19-9/TB, CA19-9/DB and CA19-9/ALP ratios using Cox regression, receiver operating characteristic (ROC) analyses, and area under the curve (AUC) estimates. Results: In univariate analysis in the group without jaundice, both high CA19-9 and high CA19-9/TB ratio were associated with poor OS, whereas other parameters were not. ROC-AUC for OS prediction was greater in CA19-9 than in the CA19-9/TB ratio, and CA19-9 was identified as an independent prognosticator in multivariate analysis. In the group with jaundice, CA19-9 was not significant; however, CA19-9/TB, CA19-9/DB, and CA19-9/ALP ratios were all associated with poor OS. In ROC-AUC analysis, CA19-9/ALP ratio showed the highest predictive value; furthermore, it was an independent prognosticator in multivariate analysis. Conclusion: Adjustment of the CA19-9 value was less useful as a predictor in the absence of jaundice. On the other hand, the CA19-9/ALP ratio showed superior prognostic value in jaundiced patients with eBTC.

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<p>Preoperative Bilirubin-Adjusted Carbohydrate Antigen 19-9 as a Prognostic Factor for Extrahepatic Cholangiocarcinoma Patients at a Single Center</p>

Cited by 3 publications

References 38 publications

The Diagnostic Value of the CA19-9 and Bilirubin Ratio in Patients with Pancreatic Cancer, Distal Bile Duct Cancer and Benign Periampullary Diseases, a Novel Approach

The Diagnostic Value of the CA19-9 and Bilirubin Ratio in Patients with Pancreatic Cancer, Distal Bile Duct Cancer and Benign Periampullary Diseases, a Novel Approach

Retrospective study of preoperative CA199 combined control nutritional status score to predict the prognosis of distal cholangiocarcinoma

Preoperative Alkaline Phosphatase-adjusted CA19-9 as a Superior Prognosticator for Extrahepatic Biliary Tract Cancer With Jaundice

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