Wang Zhicong, Shi Yabo, Xiong Ganwei, Han Mengxi, Chen Xiaoliang
Department of Hepatobiliary Surgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, China.
Department of General Surgery, Yellow River Sanmenxia Hospital, Sanmenxia, 472000, China.
Discov Oncol. 2024 Dec 18;15(1):773. doi: 10.1007/s12672-024-01683-w.
This study aimed to determine the prognostic survival impact of preoperative carbohydrate CA19-9 levels in resectable cholangiocarcinoma.
PubMed, Web of Science, Cochrane, and Embase databases were searched for articles published through April 28, 2023. The relationship between preoperative serum carbohydrate antigen 19-9 and the prognosis of patients with resectable cholangiocarcinoma was analyzed. Heterogeneity between studies was assessed by means of the I statistic. We also performed subgroup analyses based on anatomical site of the tumor, geographic region, time of occurrence, and different levels of CA19-9. A random effects model was performed to express effect sizes as Hazard Ratio (HR) with 95% confidence intervals (CIs).
A total of 60 original studies were eligible for inclusion, with a total of 15,031 patients with all sites, including 9014 males. The overall Hazard Ratio for all studies was 1.90 (95% CI 1.74-2.07, p < 0.001, Z = 14.59). Publication bias was suggested by the Begg's test (p = 0.014 < 0.05), and the overall HR was 1.66 (95% CI 1.53-1.80, p < 0.001, Z = 12.027) after the trim-and-filling method. Subgroup analyses showed that intrahepatic cholangiocarcinoma (HR = 2.00, 95% CI 1.79-2.23), extrahepatic cholangiocarcinoma (HR = 1.65, 95% CI 1.49-1.82), hilar cholangiocarcinoma (HR = 1. 82, 95% CI 1.60-2.07), and distal cholangiocarcinoma (HR = 1.66, 95% CI 1.27-2.15) were predicted to be linked with prognosis. Elevated CA19-9 levels were associated with an increased risk of death.
This meta-analysis showed that elevated CA19-9 levels were correlated with a poor prognosis in cholangiocarcinoma. In future, more distal and hilar cholangiocarcinoma should be included in statistical studies to improve the accuracy of our conclusions.
本研究旨在确定术前糖类抗原19-9（CA19-9）水平对可切除胆管癌患者生存预后的影响。
检索PubMed、Web of Science、Cochrane和Embase数据库中截至2023年4月28日发表的文章。分析术前血清CA19-9与可切除胆管癌患者预后的关系。采用I统计量评估研究间的异质性。我们还根据肿瘤的解剖部位、地理区域、发病时间和不同的CA19-9水平进行了亚组分析。采用随机效应模型将效应大小表示为风险比（HR）及95%置信区间（CI）。
共有60项原始研究符合纳入标准，涉及所有部位的15031例患者，其中男性9014例。所有研究的总体风险比为1.90（95%CI 1.74-2.07，p<0.001，Z=14.59）。Begg检验提示存在发表偏倚（p=0.014<0.05），采用修剪填充法后总体HR为1.66（95%CI 1.53-1.80，p<0.001，Z=12.027）。亚组分析显示，肝内胆管癌（HR=2.00，95%CI 1.79-2.23）、肝外胆管癌（HR=1.65，95%CI 1.49-1.82）、肝门部胆管癌（HR=1.82，95%CI 1.60-2.07）和远端胆管癌（HR=1.66，95%CI 1.27-2.15）预计与预后相关。CA19-水平升高与死亡风险增加相关。
这项荟萃分析表明，CA19-9水平升高与胆管癌预后不良相关。未来，应将更多的远端和肝门部胆管癌纳入统计研究，以提高我们结论的准确性。
