联合肿瘤负荷评分与糖类抗原19-9分级系统预测肝内胆管癌患者的预后
Combined Tumor Burden Score and Carbohydrate Antigen 19-9 Grading System to Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma.
作者信息
Moazzam Zorays, Alaimo Laura, Endo Yutaka, Lima Henrique A, Ruzzenente Andrea, Guglielmi Alfredo, Aldrighetti Luca, Weiss Matthew, Bauer Todd W, Alexandrescu Sorin, Poultsides George A, Maithel Shishir K, Marques Hugo P, Martel Guillaume, Pulitano Carlo, Shen Feng, Cauchy François, Koerkamp Bas Groot, Endo Itaru, Cloyd Jordan, Ejaz Aslam, Pawlik Timothy M
机构信息
From the Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Moazzam, Alaimo, Endo, Lima, Cloyd, Ejaz, Pawlik).
Department of Surgery, University of Verona, Verona, Italy (Ruzzenente, Guglielmi).
出版信息
J Am Coll Surg. 2023 Apr 1;236(4):804-813. doi: 10.1097/XCS.0000000000000557. Epub 2023 Jan 12.
BACKGROUND
The interplay of carbohydrate antigen 19-9 (CA19-9) and tumor burden score (TBS) within intrahepatic cholangiocarcinoma remains ill-defined. We evaluated the roles of TBS and CA19-9 relative to overall survival (OS) and recurrence, as well as the predictive ability of the combined TBS and CA19-9 (CTC) grading system.
STUDY DESIGN
Patients undergoing liver resection for intrahepatic cholangiocarcinoma between 2000 and 2020 were identified using a multi-institutional database. The impact of CA19-9 and TBS on 5-year OS and 3-year recurrence was assessed, along with the prognostic accuracy of the CTC grading system (ie the composite score of CA19-9 level and TBS).
RESULTS
Among 831 patients, the median age was 58.2 years and 482 (58.0%) were male. The median [IQR] CA19-9 level was 49.7 [17.0, 221.0] U/mL and TBS was 6.1 [4.1, 8.3]. Median [IQR] and 5-year OS were 36.9 [32.3, 43.1] months and 38.9%, respectively; 3-year recurrence was 68.9%. Five-year survival varied relative to CA19-9 (low vs high, 49.0% vs 19.7%) and TBS (low vs high, 53.6% vs 26.9%) (p < 0.001 for both). On multivariable analysis, high CA19-9 (hazard ratio [HR] 2.02, 95% CI 1.64 to 2.49) and high TBS (HR 1.64, 95% CI 1.32 to 2.06) remained independently associated with OS. In turn, the CTC grading score stratified 5-year OS (low vs intermediate vs high CTC, 57.7% vs 39.9% vs 12.6%; p < 0.001) and remained an independent prognostic factor (referent, low CTC; [intermediate CTC] HR 1.54, 95% CI 1.18 to 2.01; [high CTC] HR 3.28, 95% CI 2.47 to 4.36).
CONCLUSIONS
The interplay between tumor morphology and biology dictates long-term prognosis after liver resection for intrahepatic cholangiocarcinoma. Prognostic models such as the CTC grading system may inform discussions around prognosis, as well as help identify which patients with ICC may benefit more from neoadjuvant chemotherapy rather than up-front surgery.
背景
肝内胆管癌中糖类抗原19-9（CA19-9）与肿瘤负荷评分（TBS）之间的相互作用仍不明确。我们评估了TBS和CA19-9相对于总生存期（OS）和复发的作用，以及联合TBS和CA19-9（CTC）分级系统的预测能力。
研究设计
使用多机构数据库识别2000年至2020年间接受肝内胆管癌肝切除术的患者。评估CA19-9和TBS对5年总生存期和3年复发的影响，以及CTC分级系统（即CA19-9水平和TBS的综合评分）的预后准确性。
结果
831例患者中，中位年龄为58.2岁，482例（58.0%）为男性。CA19-9水平的中位数[四分位间距]为49.7[17.0，221.0]U/mL，TBS为6.1[4.1，8.3]。中位[四分位间距]和5年总生存期分别为36.9[32.3，43.1]个月和38.9%；3年复发率为68.9%。5年生存率因CA19-9（低水平vs高水平，49.0% vs 19.7%）和TBS（低水平vs高水平，53.6% vs 26.9%）而异（两者p均<0.001）。多变量分析显示，高CA19-9（风险比[HR]2.02，95%置信区间1.64至2.49）和高TBS（HR 1.64，95%置信区间1.32至2.06）仍与总生存期独立相关。相应地，CTC分级评分对5年总生存期进行了分层（低CTC vs中CTC vs高CTC，57.7% vs 39.9% vs 12.6%；p<0.001），并且仍然是一个独立的预后因素（参照，低CTC；[中CTC]HR 1.54，95%置信区间1.18至2.01；[高CTC]HR 3.28，95%置信区间2.47至4.36）。
结论
肿瘤形态与生物学之间的相互作用决定了肝内胆管癌肝切除术后的长期预后。诸如CTC分级系统之类的预后模型可能有助于围绕预后进行讨论，也有助于确定哪些肝内胆管癌患者可能从新辅助化疗而非 upfront手术中获益更多。
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