Tumor markers as a diagnostic key for hilar cholangiocarcinoma
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august 20, 2010 Eur J Med Res (2010) 15: 357-361
357 © I. Holzapfel Publishers 2010
TuMoR MaRkERs as a DIagnosTIc kEy foR HIlaR cHolangIocaRcInoMa B. Juntermanns1, s. Radunz1, M. Heuer1, s. Hertel 2, H. Reis 3, J. P. neuhaus1, s. Vernadakis1, T. Trarbach 4, a. Paul1, g. M. kaiser1 1Department of general, Visceral and Transplantation surgery, university Hospital of Essen, germany, 2 Institute for Medical Informatics, Biometry and Epidemiology, university Hospital of Essen, germany, 3 Institute of Pathology and neuropathology, university Hospital of Essen, germany, 4 Department of Medicine, West german cancer centre, university Hospital of Essen, germany
Abstract Objective: Hilar cholangiocarcinoma is the fourth most common gastrointestinal malignancy. ca19-9 and cEa are helpful devices in the management of gastrointestinal malignancies and belong to clinical routine in surgical oncology. But the validity of these parameters in terms of tumor extension and prognosis of bile duct malignancies still remains unclear. Methods: from 1998 to 2008, we obtained preoperative ca19-9 and cEa serum levels in 136 patients with hilar cholangiocarcinoma. We correlated tumor stage, resectability rate and survival with preoperative ca 19-9 and cEa serum levels. Results: ca19-9 (uIcc I: 253 ± 561u/ml; uIcc II: 742 ± 1572 u/ml; uIcc III: 906 ± 1708 u/ml; uIcc IV: 1707 ± 3053u/ml) and cEa levels (uIcc I: 2.9 ± 3.8u/ml; uIcc II: 4.6 ± 6.5 u/ml; uIcc III: 18.1 ± 29.6 u/ml; uIcc IV: 22.7 ± 53.9 u/ml) increase significantly with rising tumor stage. Patients with preoperative serum levels of ca19-9 (>1000u/ml) and cEa (>14.4ng/ml) showed a significant poorer resectability rate and survival than patients with lower ca19-9 and cEa serum levels respectively. Conclusion: ca19-9 and cEa serum levels are associated with the tumor stage. If preoperatively obtained ca19-9 and cEa serum levels are highly elevated patients have an even worse survival and the frequency of irresectability is significantly higher. Key words: bile duct cancer, ca19-9, cEa, hilar cholangiocarcinoma, klatskin-tumor, tumor staging
InTRoDucTIon Hilar cholangiocarcinoma is a primary cancer of the bile ducts located at the hilar bifurcation [1]. according to the proximal tumor extension the hilar cholangiocarcinoma is classified by Bismuth-corlette [2]. It is quite a rare malignant tumor (yearly incidence of 2-4 out of 100,000 patients), but nevertheless the fourth most common gastrointestinal malignancy [3). Previous studies report that the 5-year survival rate after curative resection was between 28-40% [4]. The resectability rate of patients operated for hilar cholangiocarcinoma is 61% at our institution and
therefore comparable to recently published investigations [5]. Hilar cholangiocarcinoma arises from malignant transformation of cholangiocytes, the epithelial cells that line the biliary ducts. Risk factors that have been associated with the development of cholangiocarcinoma are age ≥ 65 years, primary sclerosing cholangitis (Psc), hepatobiliary flukes (Opisthorchis
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