P-119 - Prognostic value of CA 19-9 kinetics during gemcitabine-based chemotherapy in patients with advanced cholangiocarcinoma

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Hepatobiliary Cancers
Translational Research
Presenter S.H. Lee
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors S.H. Lee1, B.S. Lee2, J. Ryu3, Y.-. Kim1
  • 1Seoul National University College of Medicine, Seoul/KR
  • 2Kyungpook National University College of Medicine, Daegu/KR
  • 3Seoul National University Hospital, Seoul/KR

Abstract

Introduction

Little is known of the prognostic value of CEA/CA19-9 kinetics during chemotherapy in patients with advanced cholangiocarcinoma (CCA). The aim of this study was to evaluate the association between the change in CEA and CA 19-9 level during gemcitabine-based chemotherapy and survival in patients with advanced CCA.

Methods

A total of 236 patients with pathologically-confirmed advanced CCA received gemcitabine-based chemotherapy were reviewed, and 179 were eligible for analysis. Baseline, pre-, and post-treatment (after two cycles of chemotherapy) CEA and CA 19-9 values were checked, and survival was compared according to various cutting points of baseline measurement or extent of change of tumor marker level.

Results

Patients with a ≥ 50% decline in CA 19-9 level had better survival than the others (16.0 vs. 9.0 months). However, CEA decline did not predict survival gain. Significant prognostic factors of survival in multivariable analysis included ≥ 50% decline in CA 19-9 level (HR 0.48), distal location of tumor (HR 0.50), and baseline CA 19-9 level ≤ 1000 U/ml (HR 0.53). Subgroup analysis was conducted in 114 patients with pre-treatment CA 19-9 > 37 U/ml and bilirubin ≤ 2 mg/dL. Decline ≥ 50% in CA 19-9 level still showed an independent prognostic significance (HR 0.42).

Conclusion

CA19-9 but not CEA kinetics serves as a predictor of better survival in patients with advanced CCA on gemcitabine-based chemotherapy. A ≥ 50% decline in CA 19-9 level after two cycles of chemotherapy may have clinical utility as an early indicator of better response to gemcitabine-based chemotherapy.