The evaluation of tumor markers and their impact on prognosis in gallbladder, bile duct, and cholangiocellular carcinomas – A pilot study

Abstract

Background: The aim was to construct a risk score model to predict IGBC, developed through statistical modelling, based on our groups previous findings. Methods: Data from cholecystectomies registered in the Nationwide Swedish Register for Gallstone Surgery were analysed. The derivation cohort underwent surgery 2007-2014 and the validation cohort 2015-2016. From the multivariable logistic regression in the derivation cohort, an additive risk model, based on the odds ratio, was constructed and validated. The scoring model's ability to predict IGBC was estimated by AUROC and Hosmer-Lemeshow (HL) test. Results: The derivation cohort consisted of in total 36,355 patients, including 215 with IGBC, who underwent cholecystectomy. Age (41 years 0 points, 42-66 years 10p, 67 years 50p), female gender (3.5p), previous cholecystitis (1.5p) and the combination jaundice without acute cholecystitis (2.5) and acute cholecystitis without jaundice (1.5p) were significantly associated with IGBC. The accuracy of the model was assessed both on the derivation cohort, and in the validation set of 9,948 patients, including 42 with IGBC. The AUROC scores for predicting IGBC were 0.80 (CI:0.77-0.83) in the derivation cohort and 0.78 (CI:0.72-0.84) in the validation cohort, with a good calibration (HL test, p=0.19). Conclusion: We present the first risk score model to predict IGBC. The model is based on five easily registered clinically relevant variables. This validated model may help to optimize treatment strategies in high risk patients.

The prognostic impact of neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) in patients with distal bile duct cancer

“…Our study highlights that preoperative NLR and LMR values were independent predictors of OS in patients with DBDC who underwent pancreaticoduodenectomy. Several studies have reported that preoperative indicators, such as serum albumin and CRP levels, as well as widely recognized tumor markers (CEA and CA 19-9) may also serve as prognostic indicators of biliary tract cancer outcomes [10][11][12][13][14]; however, the NLR and LMR scored over these factors in this study. The prognostic value of these inflammatory biomarkers has been demonstrated in biliary tract cancer [15,16].…”

Systematic review of management of incidental gallbladder cancer after cholecystectomy

“…In incidental gallbladder cancer, tumour markers are usually not available from the preoperative assessment, and thus the prognostic role of frequently used tumour markers such as carbohydrate antigen (CA) 19‐9 or carcinoembryonic antigen (CEA) is not known. For gallbladder cancer in general, a high preoperative CA 19‐9 or CEA value is considered a poor prognostic sign, as it relates to tumour burden. In general, the prognostic accuracy of both CEA and CA 19‐9 is rather low and non‐specific for raised values, and the best information may be having a value within the normal range, which is usually associated with a good prognosis.…”

“…For gallbladder cancer in general, a high preoperative CA 19‐9 or CEA value is considered a poor prognostic sign, as it relates to tumour burden. In general, the prognostic accuracy of both CEA and CA 19‐9 is rather low and non‐specific for raised values, and the best information may be having a value within the normal range, which is usually associated with a good prognosis. Other tumour markers, such as CA 242 and thymidine kinase, have been proposed as promising or better than CEA and CA 19‐9, but are non‐specific and require further validation.…”

“…In general, the prognostic accuracy of both CEA and CA 19‐9 is rather low and non‐specific for raised values, and the best information may be having a value within the normal range, which is usually associated with a good prognosis. Other tumour markers, such as CA 242 and thymidine kinase, have been proposed as promising or better than CEA and CA 19‐9, but are non‐specific and require further validation. In patients considered for reresection, with suspicious findings on CT or PET, an increased CA 19‐9 level may suggest underlying occult disease and the need for an observational strategy rather than extended redo surgery.…”

Second‐line chemotherapy in biliary tract cancer: Outcome and prognostic factors

“…However, the impact of CEA as well as CA 19-9 levels on survival in BTC is contradictive. 19,[21][22][23] One reason for the inconclusive results may be the different cutoff values that were used in the respective studies. In our study, we used the ULN as cutoff values.…”