Heng Gang, Huang Benqi, Shen Yanbing, Wang Dan, Lan Zhen, Yao Yuxuan, Zhang Jianxin, Jia Jiankun, Zhang Chengcheng
Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China.
Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China.
Front Oncol. 2022 Dec 12;12:1071439. doi: 10.3389/fonc.2022.1071439. eCollection 2022.
Carbohydrate antigen 242 has been clinically used as a diagnostic biomarker for pancreatic cancer. However, the prognostic role of CA242 in hilar cholangiocarcinoma (HCCA) has not been identified. Also, it remains unclear to what extents the vascular invasion and lymph node metastasis mediate the effect of serum CA242 on prognosis.
This study aimed to investigate whether vascular invasion and lymph node metastasis mediate the relationship between CA242 levels and clinical prognosis in HCCA patients after radical resection.
Data of 234 HCCA patients who accepted radical resection from March 2008 to December 2014 were analyzed. Vascular invasion and lymph node metastasis were assessed by postoperative pathological examinations. Mediation analysis was performed to study the potential causal relationship between CA242 and overall survival (OS) and relapse-free survival (RFS). Survival analysis was performed using the Kaplan-Meier method.
Among 234 HCCA patients, 104 patients (44.4%) with normal CA242 levels (≤ 20 IU/ml) had significantly better OS (p=0.004) and RFS (p=0.001) than those 130 patients (55.6%) with elevated CA242 levels (>20 IU/ml). The logistic analysis showed that elevated CA242 was an independent risk factor for vascular invasion (p=0.006) and lymph nodes metastasis (p=0.040). The causal mediation analysis indicated that the vascular invasion (p=0.012 for OS; p=0.036 for RFS) and lymph nodes metastasis (p=0.024 for OS; p=0.014 for RFS) played significant roles in mediating the effect of serum CA242 on OS and RFS.
Serum elevated CA242 could be a novel marker for prognosis prediction in HCCA patients. Vascular invasion and lymph node metastasis mediated the relationship between CA242 and clinical prognosis.
碳水化合物抗原242已在临床上用作胰腺癌的诊断生物标志物。然而，CA242在肝门部胆管癌（HCCA）中的预后作用尚未明确。此外，血管侵犯和淋巴结转移在多大程度上介导血清CA242对预后的影响仍不清楚。
本研究旨在探讨血管侵犯和淋巴结转移是否介导根治性切除术后HCCA患者CA242水平与临床预后之间的关系。
分析2008年3月至2014年12月接受根治性切除的234例HCCA患者的数据。通过术后病理检查评估血管侵犯和淋巴结转移情况。进行中介分析以研究CA242与总生存期（OS）和无复发生存期（RFS）之间的潜在因果关系。采用Kaplan-Meier法进行生存分析。
在234例HCCA患者中，104例（44.4%）CA242水平正常（≤20 IU/ml）的患者的OS（p=0.004）和RFS（p=0.001）显著优于130例（55.6%）CA242水平升高（>20 IU/ml）的患者。逻辑分析表明，CA242水平升高是血管侵犯（p=0.006）和淋巴结转移（p=0.040）的独立危险因素。因果中介分析表明，血管侵犯（OS为p=0.012；RFS为p=0.036）和淋巴结转移（OS为p=0.024；RFS为p=0.014）在介导血清CA242对OS和RFS的影响中起重要作用。
血清CA242水平升高可能是HCCA患者预后预测的新标志物。血管侵犯和淋巴结转移介导了CA242与临床预后之间的关系。
