Long-term prognosis of patients with gallbladder carcinoma after curative-intent resection based on changes in the ratio of carbohydrate antigen 19-9 to total bilirubin (CA19-9/TB): a multicenter retrospective cohort study

作者全名：Li, Xue-Lei; Liu, Zhi-Peng; Su, Xing-Xing; Gong, Yi; Yang, Yi-Shi; Zhao, Xiao-Lin; Li, Zi-Mu; Ding, Jun-Jie; Zhu, Yi; Yin, Da-Long; Yu, Chao; Zhou, Jin-Xue; Zhang, Dong; Ding, Rui; Chen, Wei; Cheng, Yao; Yue, Ping; Wang, Zi-Ran; Zhang, Yan-Qi; Jiang, Yan; Yin, Xian-Yu; Bai, Jie; Dai, Hai-Su; Lau, Wan Yee; Chen, Zhi-Yu

作者地址：[Li, Xue-Lei; Liu, Zhi-Peng; Su, Xing-Xing; Gong, Yi; Yang, Yi-Shi; Zhao, Xiao-Lin; Li, Zi-Mu; Ding, Jun-Jie; Jiang, Yan; Yin, Xian-Yu; Bai, Jie; Dai, Hai-Su; Chen, Zhi-Yu] Army Med Univ, Third Mil Med Univ, Southwest Hosp, Dept Hepatobiliary Surg, 30 Gaotanyan Rd, Chongqing 400038, Peoples R China; [Zhang, Yan-Qi] Army Med Univ, Third Mil Med Univ, Coll Mil Prevent Med, Dept Hlth Stat, Chongqing, Peoples R China; [Cheng, Yao] Chongqing Med Univ, Affiliated Hosp 2, Dept Hepatobiliary Surg, Chongqing, Peoples R China; [Zhu, Yi] Zhejiang Univ, Affiliated Hosp 2, Dept Hepatobiliary Surg, Hangzhou, Peoples R China; [Wang, Zi-Ran] 903rd Hosp Peoples Liberat Army, Dept Gen Surg, Hangzhou, Peoples R China; [Yu, Chao] Guizhou Med Univ, Affiliated Hosp, Dept Hepatobiliary Surg, Guiyang, Guizhou, Peoples R China; [Zhou, Jin-Xue] Henan Prov Tumor Hosp, Dept Hepatobiliary Pancreat Surg, Zhengzhou, Peoples R China; [Zhang, Dong] Xi An Jiao Tong Univ, Affiliated Hosp 1, Dept Hepatobiliary Surg, Xian, Peoples R China; [Ding, Rui] Air Force Med Univ, Fourth Mil Med Univ, Xijing Hosp, Dept Hepatobiliary Surg, Xian, Peoples R China; [Chen, Wei] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Hepatobiliary Surg, Zhongshan, Peoples R China; [Yang, Yi-Shi] Lanzhou Univ, Army Hosp 96604, Hosp 1, Dept Surg 2, Lanzhou, Peoples R China; [Yue, Ping] Lanzhou Univ, Hosp 1, Dept Hepatobiliary Surg, Lanzhou, Peoples R China; [Yin, Da-Long] Univ Sci & Technol China, Affiliated Hosp 1, Dept Hepatobiliary Surg, Hefei, Peoples R China; [Liu, Zhi-Peng] Tsinghua Univ, Tsinghua Changgung Hosp, Hepatopancreato Biliary Ctr, Beijing, Peoples R China; [Lau, Wan Yee] Chinese Univ Hong Kong, Prince Wales Hosp, Fac Med, Shatin, 7-F Clin Sci Bldg, Hong Kong 999077, Peoples R China

通信作者：Dai, HS; Chen, ZY (通讯作者)，Army Med Univ, Third Mil Med Univ, Southwest Hosp, Dept Hepatobiliary Surg, 30 Gaotanyan Rd, Chongqing 400038, Peoples R China.; Lau, WY (通讯作者)，Chinese Univ Hong Kong, Prince Wales Hosp, Fac Med, Shatin, 7-F Clin Sci Bldg, Hong Kong 999077, Peoples R China.

来源：INTERNATIONAL JOURNAL OF SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001248212000034

JCR分区：Q1

影响因子：12.5

年份：2024

卷号：110

期号：6

开始页：3580

结束页：3590

文献类型：Article

关键词：adjuvant therapy; carbohydrate antigen 19-9; curative-intent resection; gallbladder carcinoma

摘要：Background: The prognostic value of carbohydrate antigen 19-9 (CA19-9) is known to be affected by elevated bilirubin levels in patients with gallbladder carcinoma (GBC). The clinical significance of changes in the ratio of CA19-9 levels to total bilirubin (TB) levels in patients with GBC after curative-intent resection remains unknown. The aim of this study was to determine the prognostic value of changes in preoperative and postoperative CA19-9/TB ratio in these patients. Methods: Prospectively collected data on consecutive patients who underwent curative-intent resection for GBC between January 2015 and December 2020 stored in a multicenter database from 10 hospitals were analyzed in this retrospective cohort study. Based on the adjusted CA19-9 defined as the ratio of CA19-9 to TB, and using 2x10(3) U/mu mol as the upper normal value, patients were divided into a normal group (with normal preoperative and postoperative adjusted CA19-9), a normalization group (with abnormal preoperative but normal postoperative adjusted CA19-9), and a non-normalization group (with abnormal postoperative adjusted CA19-9). The primary outcomes were overall survival (OS) and recurrence-free survival (RFS). The log-rank test was used to compare OS and RFS among the groups. The Cox regression model was used to determine factors independently associated with OS and RFS. Results: The normal group (n=179 patients) and the normalization group (n=73 patients) had better OS and RFS than the non-normalization group (n=65 patients) (the 3-year OS rates 72.0%, 58.4% and 24.2%, respectively; the RFS rates 54.5%, 25.5% and 11.8%, respectively; both P<0.001). There were no significant differences between the normal and the normalization groups in OS and RFS (OS, P=0.255; RFS, P=0.130). Cox regression analysis confirmed that the non-normalization group was independently associated with worse OS and RFS. Subgroup analysis revealed that the non-normalization group of patients who received adjuvant therapy had significantly improved OS and RFS as compared to those who did not receive adjuvant therapy (OS, P=0.025; RFS, P=0.003). Conclusions: Patients with GBC who underwent curative-intent surgical resection with postoperative abnormal levels of adjusted CA19-9 (the CA19-9/TB ratio) were associated with poorer long-term survival outcomes. Adjuvant therapy after surgery improved the long-term outcomes of these patients.

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