BACKGROUND Distal cholangiocarcinoma (DCC) is a rare malignancy and validated prognostic markers remain scarce. We aimed to evaluate the role of serum CA19-9 as a potential biomarker in DCC. METHODS Patients operated for DCC at 6 high-volume surgical centers from 1994 to 2015 were identified from prospectively maintained databases. Patient baseline characteristics, surgical and histopathological parameters, as well as overall survival after resection were assessed for correlation with preoperative bilirubin-adjusted serum carbohydrate antigen 19-9 (CA19-9). Preoperative CA19-9 to bilirubin ratio (CA19-9/BR) was classified as elevated (≥ 25 U/ml/mg/dl) according to the upper serum normal values of CA19-9 (37 U/ml) and bilirubin (1.5 mg/dl) giving a cut-off at ≥ 25 U/ml/mg/dl. RESULTS In total 179 patients underwent resection for DCC during the study period. High preoperative CA19-9/BR was associated with advanced age and regional lymph node metastases. Median overall survival after resection was 27 months. Elevated preoperative serum CA19-9/bilirubin ratio (HR 1.6, p = 0.025), T3/4 stage (HR 1.8, p = 0.022), distant metastasis (HR 2.5, p = 0.007), tumor grade (HR 1.9, p = 0.001) and R status (HR 1.7, p = 0.023) were identified as independent negative prognostic factors following multivariable analysis. CONCLUSION Elevated preoperative bilirubin-adjusted serum CA19-9 correlates with regional lymph node metastases and constitutes a negative independent prognostic factor after resection of DCC.

中文翻译：

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179例远端胆管癌患者多中心亚组分析中，术前胆红素调整后的血清糖类抗原19-9的预后相关性。

背景技术远端胆管癌（DCC）是一种罕见的恶性肿瘤，经过验证的预后指标仍然很少。我们旨在评估血清CA19-9作为DCC中潜在的生物标志物的作用。方法从前瞻性维护的数据库中识别出1994年至2015年在6个大容量手术中心接受DCC手术的患者。评估患者基线特征，手术和组织病理学参数以及切除后的总生存率，以与术前经胆红素调整的血清糖类抗原19-9（CA19-9）相关。术前CA19-9与胆红素之比（CA19-9 / BR）根据血清CA19-9（37 U / ml）和胆红素（1.5的血清正常值）的升高归为升高（≥25 U / ml / mg / dl）。 mg / dl）的截断值≥25 U / ml / mg / dl。结果在研究期间，共有179例患者接受了DCC切除术。术前高CA19-9 / BR与高龄和区域淋巴结转移有关。切除后中位总生存期为27个月。术前血清CA19-9 /胆红素比率升高（HR 1.6，p = 0.025），T3 / 4期（HR 1.8，p = 0.022），远处转移（HR 2.5，p = 0.007），肿瘤分级（HR 1.9，p = 0.001）和R状态（HR 1.7，p = 0.023）在多变量分析后被确定为独立的阴性预后因素。结论术前胆红素调整的血清CA19-9升高与区域淋巴结转移相关，构成DCC切除后阴性的独立预后因素。切除后中位总生存期为27个月。术前血清CA19-9 /胆红素比率升高（HR 1.6，p = 0.025），T3 / 4期（HR 1.8，p = 0.022），远处转移（HR 2.5，p = 0.007），肿瘤分级（HR 1.9，p = 0.001）和R状态（HR 1.7，p = 0.023）在多变量分析后被确定为独立的阴性预后因素。结论术前胆红素调整的血清CA19-9升高与区域淋巴结转移相关，构成DCC切除后阴性的独立预后因素。切除后中位总生存期为27个月。术前血清CA19-9 /胆红素比率升高（HR 1.6，p = 0.025），T3 / 4期（HR 1.8，p = 0.022），远处转移（HR 2.5，p = 0.007），肿瘤分级（HR 1.9，p = 0.001）和R状态（HR 1.7，p = 0.023）在多变量分析后被确定为独立的阴性预后因素。结论术前胆红素调整的血清CA19-9升高与区域淋巴结转移相关，构成DCC切除后阴性的独立预后因素。023）被确定为独立的阴性预后因素，经过多变量分析。结论术前胆红素调整的血清CA19-9升高与区域淋巴结转移相关，构成DCC切除后阴性的独立预后因素。023）被确定为独立的阴性预后因素，经过多变量分析。结论术前胆红素调整的血清CA19-9升高与区域淋巴结转移相关，构成DCC切除后阴性的独立预后因素。