title: Clinical value of preoperative serum CA 19-9 and CA 125 levels in predicting the resectability of hilar cholangiocarcinoma.
abstract: BACKGROUND
  To examine the predictive value of tumor markers for evaluating tumor resectability in patients with hilar cholangiocarcinoma and to explore the prognostic effect of various preoperative factors on resectability in patients with potentially resectable tumors. Patients with potentially resectable tumors judged by radiologic examination were included. The receiver operating characteristic (ROC) analysis was conducted to evaluate serum carbohydrate antigenic determinant 19-9 (CA 19-9), carbohydrate antigen 125 (CA 125) and carcino embryonie antigen levels on tumor resectability. Univariate and multivariate logistic regression models were also conducted to analysis the correlation of preoperative factors with resectability.
  
  
  RESULTS
  In patients with normal bilirubin levels, ROC curve analysis calculated the ideal CA 19-9 cut-off value of 203.96 U/ml in prediction of resectability, with a sensitivity of 83.7 %, specificity of 80 %, positive predictive value of 91.1 % and negative predictive value of 66.7 %. Meanwhile, the optimal cut-off value for CA 125 to predict resectability was 25.905 U/ml (sensitivity, 78.6 %; specificity, 67.5 %). In a multivariate logistic regression model, tumor size ≤3 cm (OR 4.149, 95 % CI 1.326-12.981, P = 0.015), preoperative CA 19-9 level ≤200 U/ml (OR 20.324, 95 % CI 6.509-63.467, P < 0.001), preoperative CA 125 levels ≤26 U/ml (OR 8.209, 95 % CI 2.624-25.677, P < 0.001) were independent determinants of resectability in patients diagnosed as hilar cholangiocarcinoma.
  
  
  CONCLUSIONS
  Preoperative CA 19-9 and CA 125 levels predict resectability in patients with radiological resectable hilar cholangiocarcinoma. Increased preoperative CA 19-9 levels and CA 125 levels are associated with poor resectability rate.
authors.affiliation: Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan Province China.
authors.forename: Hai-Jie
authors.initials: HJ
authors.lastname: Hu
authors.affiliation: Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan Province China.
authors.forename: Hui
authors.initials: H
authors.lastname: Mao
authors.affiliation: Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan Province China.
authors.forename: Yong-Qiong
authors.initials: YQ
authors.lastname: Tan
authors.affiliation: Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan Province China.|Department of General Surgery, Gandaki Medical College, Pokhara, Nepal.
authors.forename: Anuj
authors.initials: A
authors.lastname: Shrestha
authors.affiliation: Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan Province China.
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Ma
authors.affiliation: Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan Province China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan Province China.
authors.forename: Jun-Ke
authors.initials: JK
authors.lastname: Wang
authors.affiliation: Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan Province China.
authors.forename: Nan-Sheng
authors.initials: NS
authors.lastname: Cheng
authors.affiliation: Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan Province China.
authors.forename: Fu-Yu
authors.initials: FY
authors.lastname: Li
keywords: Carbohydrate antigen 125 (CA 125); Carbohydrate antigen 19-9 (CA 19-9); Hilar cholangiocarcinoma; Resectability