1.Department of Hepatobiliary
Surgery, Union Hospital, Tongji Medical College, Huazhong University
of Science and Technology, Wuhan, 430022, China; 2.National Center for
AIDS/STD Control and Prevention, Chinese Center for Disease Control
and Prevention, Beijing 100050, China;
Abstract:This study was performed to determine the prognostic role of preoperative serum carbohydrate antigen (CA) 19-9 levels in the survival of patients with cholangiocarcinoma. Articles published up to June 1st, 2010 that evaluated preoperative CA19-9 levels and the prognosis of cholangiocarcinoma were collected for meta-analysis. The required information for calculating individual relative risk (RR) was extracted from the studies, and a combined overall RR was estimated. Nine eligible studies were included. One study dealt with extra-hepatic cholangiocarcinoma, while the other eight studies analyzed intra-hepatic cholangiocarcinoma. The mean methodological quality score was 74.1%, ranging from 65.5% to 82.5%. The overall RR for the nine studies was 1.28 (95% confidence interval= 1.10–1.46), and the Z-score for overall effect was 13.83 (P<0.001). The association between serum CA19-9 level and lymph node involvement was also assessed. The combined RR was 1.471 (95% confidence interval= 0.411–5.264) and Z-score for overall effect was 0.59 (P = 0.553). CA19-9 levels were associated significantly with the prognosis of patients with cholangiocarcinoma. This meta-analysis shows that elevation of preoperative CA19-9 levels is correlated with a poor prognosis of patients with cholangiocarcinoma. However, larger scale and randomized studies are needed to draw a more substantive conclusion.
Blechacz B, Gores G J. Cholangiocarcinoma: advances in pathogenesis, diagnosis, and treatment. Hepatology, 2008, 48(1): 308–321 PMID: 18536057
Welzel T M, McGlynn K A, Hsing A W, O'Brien T R, Pfeiffer R M. Impact of classification of hilar cholangiocarcinomas (Klatskin tumors)on the incidence of intra- and extrahepatic cholangiocarcinoma inthe United States. J Natl Cancer Inst, 2006, 98(12): 873–875 PMID: 16788161
Forsmo H M, Horn A, Viste A, Hoem D, ?vreb? K. Survival and an overview of decision-making in patients with cholangiocarcinoma. Hepatobiliary Pancreat Dis Int, 2008, 7(4): 412–417 PMID: 18693178
Heimbach J K, Haddock M G, Alberts S R, Nyberg S L, Ishitani M B, Rosen C B, Gores G J. Transplantation for hilar cholangiocarcinoma. Liver Transpl, 2004, 10(10 Suppl 2): S65–S68 PMID: 15382214
Heimbach J K, Gores G J, Haddock M G, Alberts S R, Nyberg S L, Ishitani M B, Rosen C B. Liver transplantationfor unresectable perihilar cholangiocarcinoma. Semin Liver Dis, 2004, 24(2): 201–207 PMID: 15192792
Uenishi T, Hirohashi K, Kubo S, Yamamoto T, Yamazaki O, Kinoshita H. Clinicopathological factorspredicting outcome after resection of mass-forming intrahepatic cholangiocarcinoma. Br J Surg, 2001, 88(7): 969–974 PMID: 11442529
DeOliveira M L, Cunningham S C, Cameron J L, Kamangar F, Winter J M, Lillemoe K D, Choti M A, Yeo C J, Schulick R D. Cholangiocarcinoma: thirty-one-yearexperience with 564 patients at a single institution. Ann Surg, 2007, 245(5): 755–762 PMID: 17457168
Su C H, Tsay S H, Wu C C, Shyr Y M, King K L, Lee C H, Lui W Y, Liu T J, P'eng F K. Factors influencing postoperative morbidity, mortality, and survivalafter resection for hilar cholangiocarcinoma. Ann Surg, 1996, 223(4): 384–394 PMID: 8633917
Stroup D F, Berlin J A, Morton S C, Olkin I, Williamson G D, Rennie D, Moher D, Becker B J, Sipe T A, Thacker S B. Meta-analysis of observational studies in epidemiology:a proposal for reporting. Meta-analysis Of Observational Studies inEpidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008–2012 PMID: 10789670
Yusuf S, Peto R, Lewis J A, Collins R, Sleight P. Beta blockade during andafter myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis, 1985, 27(5): 335–371 PMID: 2858114
Chantajitr S, Wilasrusmee C, Lertsitichai P, Phromsopha N. Combined hepatocellular and cholangiocarcinoma: clinicalfeatures and prognostic study in a Thai population. J Hepatobiliary Pancreat Surg, 2006, 13(6): 537–542 PMID: 17139428
Yi B, Zhang B H, Zhang Y J, Jiang X Q, Zhang B H, Yu W L, Chen Q B, Wu M C. Surgical procedure and prognosis of hilarcholangiocarcinoma. Hepatobiliary PancreatDis Int, 2004, 3(3): 453–457 PMID: 15313688
Huang J L, Biehl T R, Lee F T, Zimmer P W, Ryan J A Jr. Outcomes after resectionof cholangiocellular carcinoma. Am J Surg, 2004, 187(5): 612–617 PMID: 15135676
Fernández-Ruiz M, Guerra-Vales J M, Colina-Ruizdelgado F. Comorbidity negatively influences prognosis in patients with extrahepatic cholangiocarcinoma. World J Gastroenterol, 2009, 15(42): 5279–5286 PMID: 19908335
Abdel Wahab M, Fathy O, Elghwalby N, Sultan A, Elebidy E, Abdalla T, Elshobary M, Mostafa M, Foad A, Kandeel T, Abdel Raouf A, Salah T, Abu Zeid M, Abu Elenein A, Gad Elhak N, ElFiky A, Ezzat F. Resectability and prognosticfactors after resection of hilar cholangiocarcinoma. Hepatogastroenterology, 2006, 53(67): 5–10 PMID: 16506367
Kim H J, Yun S S, Jung K H, Kwun W H, Choi J H. Intrahepatic cholangiocarcinomain Korea. J Hepatobiliary Pancreat Surg, 1999, 6(2): 142–148 PMID: 10398901
Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H, Miyazaki M. Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathologicalfactors influencing survival. Br J Surg, 2002, 89(12): 1525–1531 PMID: 12445060
Miwa S, Miyagawa S, Kobayashi A, Akahane Y, Nakata T, Mihara M, Kusama K, Soeda J, Ogawa S. Predictive factors for intrahepatic cholangiocarcinomarecurrence in the liver following surgery. J Gastroenterol, 2006, 41(9): 893–900 PMID: 17048054
Uenishi T, Yamazaki O, Tanaka H, Takemura S, Yamamoto T, Tanaka S, Nishiguchi S, Kubo S. Serum cytokeratin 19 fragment (CYFRA21-1) as a prognostic factor in intrahepatic cholangiocarcinoma. Ann Surg Oncol, 2008, 15(2): 583–589 PMID: 17955299
Zhou L, He X D, Cui Q C, Zhou W X, Qu Q, Zhou R L, Rui J A, Yu J C. Expression of LAPTM4B-35: a novel markerof progression, invasiveness and poor prognosis of extrahepatic cholangiocarcinoma. Cancer Lett, 2008, 264(2): 209–217 PMID: 18334282
Shen W F, Zhong W, Xu F, Kan T, Geng L, Xie F, Sui C J, Yang J M. Clinicopathological and prognostic analysis of 429 patientswith intrahepatic cholangiocarcinoma. World J Gastroenterol, 2009, 15(47): 5976–5982 PMID: 20014463
Jiang W, Zeng Z C, Tang Z Y, Fan J, Zhou J, Zeng M S, Zhang J Y, Chen Y X, Tan Y S. Benefit of radiotherapy for 90 patients with resected intrahepaticcholangiocarcinoma and concurrent lymph node metastases. J Cancer Res Clin Oncol, 2010, 136(9): 1323–1331 PMID: 20130909
Cho S Y, Park S J, Kim S H, Han S S, Kim Y K, Lee K W, Lee S A, Hong E K, Lee W J, Woo S M. Survival analysis of intrahepaticcholangiocarcinoma after resection. Ann Surg Oncol, 2010, 17(7): 1823–1830 PMID: 20165987
Saxena A, Chua T C, Sarkar A, Chu F, Morris D L. Clinicopathologic and treatment-related factors influencing recurrence and survival after hepatic resectionof intrahepatic cholangiocarcinoma: a 19-year experience from an establishedAustralian hepatobiliary unit. J Gastrointest Surg, 2010, 14(7): 1128–1138 PMID: 20467830
Kannagi R. Carbohydrate antigen sialyl Lewis a—its pathophysiologicalsignificance and induction mechanism in cancer progression. Chang Gung Med J, 2007, 30(3): 189–209 PMID: 17760270
Takada A, Ohmori K, Yoneda T, Tsuyuoka K, Hasegawa A, Kiso M, Kannagi R. Contribution of carbohydrate antigens sialyl Lewis Aand sialyl Lewis X to adhesion of human cancer cells to vascular endothelium. Cancer Res, 1993, 53(2): 354–361 PMID: 7678075
Briggs C D, Neal C P, Mann C D, Steward W P, Manson M M, Berry D P. Prognostic molecular markers in cholangiocarcinoma: asystematic review. Eur J Cancer, 2009, 45(1): 33–47 PMID: 18938071
Berghmans T, Paesmans M, Mascaux C, Martin B, Meert A P, Haller A, Lafitte J J, Sculier J P. Thyroid transcription factor1—a new prognostic factor in lung cancer: a meta-analysis. Ann Oncol, 2006, 17(11): 1673–1676 PMID: 16980598
Schoenleber S J, Kurtz D M, Talwalkar J A, Roberts L R, Gores G J. Prognostic role of vascular endothelial growth factor in hepatocellular carcinoma:systematic review and meta-analysis. Br J Cancer, 2009, 100(9): 1385–1392 PMID: 19401698