The power to predict with biomarkers: carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) serum markers in intrahepatic cholangiocarcinoma

Jaklitsch, Manuel; Petrowsky, Henrik

doi:10.21037/tgh.2019.03.06

Cited by 11 publications

(10 citation statements)

References 18 publications

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“…The majority of patients affected by iCCA have increased levels of CA19.9 and various cut-offs of CA19.9 serum levels (from 100 to 500 ng/ml) correlated with more advanced tumours, unresectability and poor survival. 13 Although tissue diagnosis is recommended to establish a diagnosis of iCCA, in patients with resectable lesions suspected of having cholangiocarcinoma, in which a metastatic spread has been reasonably ruled out, a liver biopsy is generally avoided because of the risk of seeding. 14 Furthermore, even with a tissue biopsy demonstrating adenocarcinoma, uncertainties remain in distinguishing iCCA from metastases arising from the colorectum, oesophagous, stomach, pancreas and lung.…”

Section: Clinical Diagnosis and General Principles Of Surgical Considmentioning

confidence: 99%

Liver resection and transplantation for intrahepatic cholangiocarcinoma

Mazzaferro

Gorgen

Roayaie

et al. 2020

Journal of Hepatology

250

182

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The incidence of intrahepatic cholangiocarcinoma (iCCA) is increasing worldwide. Although several advances have been made in the past decades to better understand this complex malignancy and to develop new treatment strategies, the prognosis of iCCA remains dismal. Liver resection (LR) is the mainstay of treatment but only a minority of patients are amenable to surgery. In most cases, patients with iCCA will require a major hepatectomy for complete resection of the tumour. This may be contraindicated or increase the surgical burden in patients with chronic liver disease and small remnant liver volume. Lymphadenectomy with a minimal harvest of 6 lymph nodes is considered adequate, as microscopic nodal metastases have been shown in more than 40% of patients. Current 5-year overall survival following LR is in the range of 25%-40%. For locally advanced disease not amenable to upfront LR, neoadjuvant locoregional therapies may be used with the aim of converting these patients to resectability or even to transplantation in well-selected cases. Recent studies have shown that liver transplantation (LT) might be a treatment option for patients with unresectable very-early iCCA (i.e. < − 2 cm), with survival outcomes comparable to those of hepatocellular carcinoma. In patients with unresectable, advanced tumours, confined to the liver who achieve sustained response to neoadjuvant treatment, LT may be considered an option within prospective protocols. The role of adjuvant therapies in iCCA is still under debate. Herein, we review the recent advances in the surgical treatment of iCCA and examine its correlation with locoregional therapies, adjuvant and neo-adjuvant strategies.

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Section: Clinical Diagnosis and General Principles Of Surgical Considmentioning

confidence: 99%

Liver resection and transplantation for intrahepatic cholangiocarcinoma

Mazzaferro

Gorgen

Roayaie

et al. 2020

Journal of Hepatology

250

182

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“…Serum CA 19-9 and CEA were most investigated in prognosis of ICC (17,18,31). Jaklitsch et al had proven that the inclusion of preoperative CA 19-9 and CEA in AJCC and LCSGJ staging systems improved the prognostic survival prediction after resection for ICC (32). Serum AFP is a widely used tumor marker of HCC (33), and the positive serum AFP (>20 ng/ml) is seen in approximately 19% of ICC patients (34).…”

Section: Discussionmentioning

confidence: 99%

A Novel Prognostic Scoring System of Intrahepatic Cholangiocarcinoma With Machine Learning Basing on Real-World Data

Liu

Zhang

et al. 2021

Front. Oncol.

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Background and ObjectivesCurrently, the prognostic performance of the staging systems proposed by the 8th edition of the American Joint Committee on Cancer (AJCC 8th) and the Liver Cancer Study Group of Japan (LCSGJ) in resectable intrahepatic cholangiocarcinoma (ICC) remains controversial. The aim of this study was to use machine learning techniques to modify existing ICC staging strategies based on clinical data and to demonstrate the accuracy and discrimination capacity in prognostic prediction.Patients and MethodsThis is a retrospective study based on 1,390 patients who underwent surgical resection for ICC at Eastern Hepatobiliary Surgery Hospital from 2007 to 2015. External validation was performed for patients from 2015 to 2017. The ensemble of three machine learning algorithms was used to select the most important prognostic factors and stepwise Cox regression was employed to derive a modified scoring system. The discriminative ability and predictive accuracy were assessed using the Concordance Index (C-index) and Brier Score (BS). The results were externally validated through a cohort of 42 patients operated on from the same institution.ResultsSix independent prognosis factors were selected and incorporated in the modified scoring system, including carcinoembryonic antigen, carbohydrate antigen 19-9, alpha-fetoprotein, prealbumin, T and N of ICC staging category in 8th edition of AJCC. The proposed scoring system showed a more favorable discriminatory ability and model performance than the AJCC 8th and LCSGJ staging systems, with a higher C-index of 0.693 (95% CI, 0.663–0.723) in the internal validation cohort and 0.671 (95% CI, 0.602–0.740) in the external validation cohort, which was then confirmed with lower BS (0.103 in internal validation cohort and 0.169 in external validation cohort). Meanwhile, machine learning techniques for variable selection together with stepwise Cox regression for survival analysis shows a better prognostic accuracy than using stepwise Cox regression method only.ConclusionsThis study put forward a modified ICC scoring system based on prognosis factors selection incorporated with machine learning, for individualized prognosis evaluation in patients with ICC.

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“…CEA is a serum tumor marker that has been used to diagnose and monitor of gastrointestinal malignancies for a long time, and its prognostic ability has been reported many times (23)(24)(25). In most previous reports, only preoperative or postoperative levels of CEA were evaluated.…”

Section: Discussionmentioning

confidence: 99%

Which is the optimal management for locally advanced gastric cancer patients with TRG 0 and 1 after R0 resection?

Ma¹,

Zhang²,

Peng³

et al. 2020

Ann Transl Med

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Background: Neoadjuvant chemotherapy (NAC) followed by surgery currently offers promise as a strategy for patients with locally advanced gastric cancer (GC). However, there is limited evidence to guide treatment for TRG 0 and 1 patients with locally advanced GC after R0 resection. This study set out to explore the optimal management for TRG 0 and 1 patients with locally advanced GC after R0 resection. Methods:The retrospective data of 154 TRG 0 and 1 patients with locally advanced GC following R0 resection who were treated between January 2012 and December 2018 were collected and analyzed. The Kaplan-Meier method was used to estimate the survival rate. Multivariate analysis was performed using the Cox proportional hazards model. Results:The median follow-up was 34.1 (range, 6.6-90.9) months. Six patients (3.9%) were lost during follow-up. Of the 27 patients who experienced relapse, 12 died, including 2 patients who died of nonneoplastic causes. The 5-year recurrence-free survival (RFS) and 5-year overall survival (OS) were 71.6% (95% CI: 68.5-79.6) and 82.9% (95% CI: 76.9-86.1) for the whole cohort, respectively. Univariate analysis revealed that patients with carcinoembryonic antigen (CEA) <5.0 ng/ml after NAC (77.7% vs. 20.1%, P<0.001), distal gastrectomy (91.7% vs. 67.5%, P=0.046) had higher 5-year RFS. Meanwhile, combined resection (55.6% vs. 73.1%, P=0.042), major complications (42.7% vs. 80.50%, P<0.001), and lymph node metastasis (ypN+) (52.0% vs. 83.7%, P<0.001) had lower 5-year RFS. The multivariate analysis showed that

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The power to predict with biomarkers: carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) serum markers in intrahepatic cholangiocarcinoma

Cited by 11 publications

References 18 publications

Liver resection and transplantation for intrahepatic cholangiocarcinoma

Liver resection and transplantation for intrahepatic cholangiocarcinoma

A Novel Prognostic Scoring System of Intrahepatic Cholangiocarcinoma With Machine Learning Basing on Real-World Data

Which is the optimal management for locally advanced gastric cancer patients with TRG 0 and 1 after R0 resection?

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