TY - JOUR
T1 - Serum tumor markers enhance the predictive power of the AJCC and LCSGJ staging systems in resectable intrahepatic cholangiocarcinoma
AU - Sasaki, Kazunari
AU - Margonis, Georgios A.
AU - Andreatos, Nikolaos
AU - Chen, Qinyu
AU - Barbon, Carlotta
AU - Bagante, Fabio
AU - Weiss, Matthew
AU - Popescu, Irinel
AU - Marques, Hugo P.
AU - Aldrighetti, Luca
AU - Maithel, Shishir K.
AU - Pulitano, Carlo
AU - Bauer, Todd W.
AU - Shen, Feng
AU - Poultsides, George A.
AU - Soubrane, Olivier
AU - Martel, Guillaume
AU - Groot Koerkamp, Bas
AU - Guglielmi, Alfredo
AU - Endo, Itaru
AU - Aucejo, Federico N.
AU - Pawlik, Timothy M.
N1 - Publisher Copyright:
© 2018 International Hepato-Pancreato-Biliary Association Inc.
PY - 2018/10
Y1 - 2018/10
N2 - Background: While several prognostic models have been developed to predict long-term outcomes in resectable intrahepatic cholangiocarcinoma (ICC), their prognostic discrimination remains limited. The addition of tumor markers might improve the prognostic power of the classification schemas proposed by the AJCC 8th edition and the Liver Cancer Study Group of Japan (LCSGJ). Methods: The prognostic discrimination of the AJCC and the LCSGJ were compared before and after the addition of CA 19-9 and CEA, using Harrell's C-index, net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) in an international, multi-institutional cohort. Results: Eight hundred and five surgically treated patients with ICC that met the inclusion criteria were identified. On multivariable analysis, CEA5 ng/mL, 100IU/mL CA 19-9< 500IU/mL and CA 19-9500 IU/mL were associated with worse overall survival. The C-index of the AJCC and the LCSGJ improved from 0.540 to 0.626 and 0.553 to 0.626, respectively following incorporation of CA 19-9 and CEA. The NRI and IDI metrics confirmed the superiority of the modified AJCC and LCSGJ, compared to the original versions. Conclusion: The inclusion of preoperative CA 19-9 and CEA in the AJCC and LCSGJ staging schemas may improve prognostic discrimination among surgically treated patients with ICC.
AB - Background: While several prognostic models have been developed to predict long-term outcomes in resectable intrahepatic cholangiocarcinoma (ICC), their prognostic discrimination remains limited. The addition of tumor markers might improve the prognostic power of the classification schemas proposed by the AJCC 8th edition and the Liver Cancer Study Group of Japan (LCSGJ). Methods: The prognostic discrimination of the AJCC and the LCSGJ were compared before and after the addition of CA 19-9 and CEA, using Harrell's C-index, net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) in an international, multi-institutional cohort. Results: Eight hundred and five surgically treated patients with ICC that met the inclusion criteria were identified. On multivariable analysis, CEA5 ng/mL, 100IU/mL CA 19-9< 500IU/mL and CA 19-9500 IU/mL were associated with worse overall survival. The C-index of the AJCC and the LCSGJ improved from 0.540 to 0.626 and 0.553 to 0.626, respectively following incorporation of CA 19-9 and CEA. The NRI and IDI metrics confirmed the superiority of the modified AJCC and LCSGJ, compared to the original versions. Conclusion: The inclusion of preoperative CA 19-9 and CEA in the AJCC and LCSGJ staging schemas may improve prognostic discrimination among surgically treated patients with ICC.
UR - http://www.scopus.com/inward/record.url?scp=85048171978&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2018.04.005
DO - 10.1016/j.hpb.2018.04.005
M3 - Article
C2 - 29887261
AN - SCOPUS:85048171978
SN - 1365-182X
VL - 20
SP - 956
EP - 965
JO - HPB
JF - HPB
IS - 10
ER -