title: Preoperative serum CA 19-9 level as a predictive factor for recurrence after curative resection in biliary tract cancer.
abstract: BACKGROUND
  Complete surgical removal of biliary tract cancer (BTC) offers the only chance of cure; however, long-term survival remains very limited because of frequent recurrence after surgery. The purpose of our study was to evaluate whether the preoperative serum carbohydrate antigen (CA) 19-9 level could predict recurrence after curative resection of BTC.
  
  
  METHODS
  We performed a retrospective review of the medical records of patients who were diagnosed with BTC and underwent curative resection. The optimal cutoff value for the preoperative serum level of CA 19-9 that predicted recurrence was determined by a ROC curve. Preoperative and postoperative risk factors for recurrence were evaluated using log-rank test.
  
  
  RESULTS
  A total of 101 patients were eligible for this study. The optimal cutoff value of preoperative serum CA 19-9 level to predict recurrence was 55 U/mL. Forty-five patients (44.6%) experienced recurrence after curative resection with a median follow-up period of 28.4 months. Recurrence occurred in 33 (61.1%) of 54 patients with CA 19-9 levels ≥55 U/mL compared with only 12 (25.5%) of 47 patients with CA 19-9 levels <55 U/mL. The recurrence rate was significantly higher in patients with baseline CA 19-9 serum levels ≥55 U/mL (hazard ratio, 3.282; 95% confidence interval, 1.684-6.395; P < 0.001).
  
  
  CONCLUSIONS
  Elevated preoperative serum CA 19-9 was associated with a high risk of recurrence after curative resection of BTC. Different treatment plans might be needed for patients with BTC and high serum levels of CA 19-9.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Moon Jae
authors.initials: MJ
authors.lastname: Chung
authors.forename: Kyong Joo
authors.initials: KJ
authors.lastname: Lee
authors.forename: Seungmin
authors.initials: S
authors.lastname: Bang
authors.forename: Seung Woo
authors.initials: SW
authors.lastname: Park
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
authors.forename: Si Young
authors.initials: SY
authors.lastname: Song
authors.forename: Jae Bock
authors.initials: JB
authors.lastname: Chung
authors.forename: Jeong Youp
authors.initials: JY
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000097:blood* / Q000601:surgery*; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000175:diagnosis*; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen