Cancer Res Treat.  2017 Jul;49(3):807-815. 10.4143/crt.2016.326.

CA19-9 or CEA Decline after the First Cycle of Treatment Predicts Survival in Advanced Biliary Tract Cancer Patients Treated with S-1 and Cisplatin Chemotherapy

Affiliations
  • 1Department of Internal Medicine and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. moisa@snu.ac.kr
  • 2Translational Medicine Major, Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 4Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.
  • 5Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
  • 6Department of Internal Medicine, Seoul Municipal Boramae Hospital, Seoul, Korea.

Abstract

PURPOSE
While tumor markers (carbohydrate antigen 19-9 [CA 19-9] and carcinoembryonic antigen [CEA]) can aid in the diagnosis of biliary tract cancer, their prognostic role has not been clearly elucidated. Therefore, this study was conducted to evaluate the prognostic role of tumor markers and tumor marker change in patients with advanced biliary tract cancer.
MATERIALS AND METHODS
Patients with pathologically proven metastatic or relapsed biliary tract cancer who were treated in a phase II trial of first-line S-1 and cisplatin chemotherapy were enrolled. Serum tumor markers were measured at baseline and after the first cycle of chemotherapy.
RESULTS
Among a total of 104 patients, 80 (77%) had elevated baseline tumor markers (69 with CA 19-9 elevation and 40 with CEA). A decline ≥ 30% of the elevated tumor marker level after the first cycle of chemotherapy conferred an improved time to progression (TTP), overall survival (OS), and better chemotherapy response. Multivariate analysis revealed tumor marker decline as an independent positive prognostic factor of TTP (adjusted hazard ratio [HR], 0.44; p=0.003) and OS (adjusted HR, 0.37; p < 0.001). Subgroup analysis revealed similar results in each group of patients with CA 19-9 elevation and CEA elevation. In addition, elevated baseline CEA was associated with poor survival in both univariate and multivariate analysis.
CONCLUSION
Tumor marker decline was associated with improved survival in biliary tract cancer. Measuring tumor marker after the first cycle of chemotherapy can be used as an early assessment of treatment outcome.

Keyword

Biliary tract neoplasms; Tumor biomarker; Carcinoembryonic antigen; CA 19-9 antigen; Antineoplastic agents

MeSH Terms

Antineoplastic Agents
Biliary Tract Neoplasms*
Biliary Tract*
Biomarkers, Tumor
CA-19-9 Antigen
Carcinoembryonic Antigen
Cisplatin*
Diagnosis
Drug Therapy*
Humans
Multivariate Analysis
Treatment Outcome
Antineoplastic Agents
Biomarkers, Tumor
CA-19-9 Antigen
Carcinoembryonic Antigen
Cisplatin

Figure

  • Fig. 1. Tumor marker change and survival. (A) Tumor marker change and time to progression. (B) Tumor marker change and overall survival.

  • Fig. 2. Carbohydrate antigen 19-9 (CA 19-9) change and survival. (A) CA 19-9 change and time to progression. (B) CA 19-9 change and overall survival.

  • Fig. 3. Carcinoembryonic antigen (CEA) change and survival. (A) CEA change and time to progression. (B) CEA change and overall survival.


Reference

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