title: Preoperative prediction of survival in resectable gallbladder cancer by a combined utilization of CA 19-9 and carcinoembryonic antigen.
abstract: BACKGROUND
  Currently, all frequently used staging systems in gallbladder cancer (GBC) are based on postoperative pathological examinations. In patients undergoing curative operation, there is no effective method to predict survival preoperatively. In this study, we explored whether a combined utilization of two tumor biomarkers, namely carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA), could give a preoperative prediction of survival in resectable GBC.
  
  
  METHODS
  Seventy-three patients who underwent radical resection for GBC were included in this study. A retrospective analysis of clinical-pathological data was conducted.
  
  
  RESULTS
  By multivariate analysis, CA 19-9 elevation (P < 0.05) and CEA elevation (P < 0.001) were discovered as two individual factors for postoperative survival. By a combined utilization, patients were divided into three groups: patients with elevation of CEA (group I), patients with elevation of CA 19-9 but without CEA (group II), and patients with nonelevations of either CA 19-9 or CEA (group III). The cumulative 5-year survival rates in groups I, II, and III were 0, 14.0%, and 42.8%, respectively (P < 0.05).
  
  
  CONCLUSIONS
  By a combined utilization of CA 19-9 and CEA, individualized prediction of survival is available in resectable GBC before operation. Extended radical operation brings the most prognostic benefits in patients with nonelevations of either CA 19-9 or CEA. However, if operation would be in a larger-scale destructive manner, careful consideration of surgical decisions should be made in patients with elevation of tumor biomarkers, especially CEA.
authors.affiliation: Second Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China.
authors.forename: Tunan
authors.initials: T
authors.lastname: Yu
authors.affiliation: Second Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Yu
authors.affiliation: Second Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China. Email: cxjzu@hotmail.com.
authors.forename: Xiujun
authors.initials: X
authors.lastname: Cai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000378:metabolism*; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D005260:Female; D005706:Gallbladder Neoplasms / Q000378:metabolism* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen