The Korean Society of Gastroenterology& SLDDS 2038 : Slide Session ; K-BP-28 : Pancreatobiliary ; Prognostic Value of CA 19-9 Kinetics during Gemcitabine-Based Chemotherapy in Patients with Advanced Cholangiocarcinoma = The Korean Society of Gastroenterology& SLDDS 2038 : Slide Session ; K-BP-28 : Pancreatobiliary ; Prognostic Value of CA 19-9 Kinetics during Gemcitabine-Based Chemotherapy in Patients with Advanced Cholangiocarcinoma

다국어 초록 (Multilingual Abstract)

Background: CA 19-9 and CEA were reported to be prognostic factors in various malignant diseases, but no studies have investigated the prognostic role of their kinetics during chemotherapy in patients with advanced cholangiocarcinoma. Methods: A total of 223 patients with inoperable cholangiocarcinoma received gemcitabine- based chemotherapy as a fi rst line regimen. Of the patients, 179 had pre-and post-treatment CEA and CA19-9 values. Baseline, pre-, and post-treatment (after 2 cycles of chemotherapy) values of those markers were checked, and survival was compared according to various cutting points of those measurements. Results: Patients with a decrease of = 50% in CA 19-9 level had better survival than the others (16.0 vs. 9.0 mon). However, CEA decline did not predict survival gain. Signifi cant prognostic factors in multivariable analysis included CA 19-9 > 1000U/ ml (HR 1.7), = 50% decline in CA 19-9 level during chemotherapy (HR 0.49), and tumor location (intra;perihilar;distal, HR=1;1.3;1.9, respectively). Subgroup analysis was conducted in 102 patients with baseline CA 19-9 > 37U/ml and bilirubin = 2mg/dL. CA 19-9 decline = 50% was also the only predictor for survival. For the validation of the cut-off point (50%) of CA19-9 decline, receiver operating characteristic analysiswas conducted to predict survival = 11 month (median value in this cohort). A value of 51.6% was the optimal cut-off decline point in CA 19-9 level, and decline of 50% had positive and negative predictive value of 80.7% and 62.0%, respectively. Conclusions: CA19-9 but not CEA kinetics serves as a predictor of better survival in patients with advaced cholangiocarcinoma on gemcitabine-based chemotherapy, and a = 50% decline in CA 19-9 level after 2 cycles of chemitherapy may have clinical utility as a early indicator of better response to gemcitabine-based chemotherapy.