title: Prognostic relevance of carbohydrate antigen 19-9 levels in patients with advanced biliary tract cancer.
abstract: Serum carbohydrate antigen 19-9 (CA 19-9) has been identified as biochemical marker for biliary tract cancer (BTC). The purpose of this study was to evaluate its value as a treatment response marker and its value as a prognostic parameter in patients with unresectable BTC. We analyzed 70 patients with BTC treated with chemotherapy. CA 19-9 levels before and after two treatment courses were analyzed with respect to their effect on treatment response. Patients were categorized into two subgroups according to biliary stenting: patients without endoscopic intervention or biliary drainage (non-stent subgroup) and patients with endoluminal stenting (stent subgroup). Pretreatment CA 19-9 levels were prognostic with respect to overall survival for the entire study population. Patients with CA 19-9 levels above the median of 300 units/mL had a nearly 3-fold risk for early death (hazard ratio, 2.92; 95% confidence interval, 1.51-5.64; adjusted P = 0.002) as compared with patients with CA 19-9 levels <or=300 units/mL. An association between CA 19-9 and therapeutic response was observed in the non-stent subgroup (P = 0.001) only. Furthermore, the decrease of CA 19-9 levels after treatment was predictive for improved survival in the non-stent subgroup (adjusted P = 0.018) but not in the stent subgroup. Our results indicate that pretreatment CA 19-9 levels and CA 19-9 decrease after chemotherapy are of prognostic relevance in patients with BTC.
authors.affiliation: Department of Medicine II, University Medical Center, Albert-Ludwigs University, Freiburg, Germany. jan.harder@uniklinik-freiburg.de
authors.forename: Jan
authors.initials: J
authors.lastname: Harder
authors.forename: Oliver
authors.initials: O
authors.lastname: Kummer
authors.forename: Manfred
authors.initials: M
authors.lastname: Olschewski
authors.forename: Florian
authors.initials: F
authors.lastname: Otto
authors.forename: Hubert Erich
authors.initials: HE
authors.lastname: Blum
authors.forename: Oliver
authors.initials: O
authors.lastname: Opitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001661:Biliary Tract Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004322:Drainage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015607:Stents; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine