Clinical Pathological Features And Prognosis Analysis Of Intrahepatic Cholangiocarcinoma With Negative CA19-9

Objective:To study clinical pathological characteristics and to explore primary prognostic factors and prognostic markers of intrahepatic cholangiocarcinoma(ICC)with negative carbohydrate antigen 19-9(CA19-9),which provide guideline for patients of subsequent therapy and follow-up.Methods:ICC patients who underwent radical surgical in the Hunan Provincial People’s Hospital(The First-affiliated Hospital of Hunan Normal University)from January 2014 to December 2018 were collected.A totall of 227 case of ICC patients were collected to the study according to the initiated inclusion and exclusion criteria.Patients were divided into 81 cases of the CA19-9 negative group(≤35U/m L)and 146 cases of the CA19-9 positive group(>35U/m L)according to their preoperative serum CA19-9 level.Clinical pathological features and survival of the two groups were compared by statistical analysis.Furthermore,to explore prognostic factors and potential prognostic prognostic markers of the CA19-9 negative ICC.Result:1.Compared with the CA19-9 positive ICC group,the incidence hepatolithiasis was lower(25.9%vs41.1%,p<0.05)in CA19-9 negative,while HBV infection was higher(24.7%vs11.0%,p<0.05).Here no significanct differences in gender,age,history of alcohol consumption,history of biliary operation and HCV infected(p>0.05).2.The positive rates of preoperative carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125)and carbohydrate antigen242(CA242)in CA19-9 negative ICC group were lower than those in CA19-9 positive group(16.0%vs30.1%,25.9%vs43.2%,12.3vs26.7%,p <0.05).Here no significant differences in the positive rate of alpha-fetoprotein(AFP)and carbohydrate antigen 153(CA153)(p >0.05).3.Comparison of the tumor histology and biological behavior showed that CA19-9 negative group was signifificantly less in nerve invasion and positive regional lymph nodes(23.5%vs39.0%,9.9%vs21.9%,p<0.05),and the proportion of stage III in TNM classification was lower than CA19-9 positive group(17.3%vs34.2%,p<0.05).Here no significant differences in tumor size,tumor number,tumor differentiation,vascular invasion,visceral peritoneum perforation and extrahepatic structures invasion between the two groups(p>0.05).4.The 1,3,5-year overall survival in CA19-9 negative ICC patients were significantly higher than that in CA19-9 positive(77.8%vs62.3%,36.8%vs23.7%,22.6%vs14.3%;p<0.05).Log-Rank Univariate analysis showed that vascular invasion,nerve invasion and regional lymph nodes metastasis as well as preoperative serum CEA and CA125 positive were risk factors for postoperative survival of CA19-9 negative ICC patients.Cox multivariate analysis showed that vascular invasion,regional lymph nodes metastasis and preoperative serum CA125 level positive were independent risk factors affecting postoperative survival of CA19-9negative ICC patients.Conclusion:1.Preoperative serum CA19-9 negative ICC may be a special subgroup compared with CA19-9 positive ICC,it shows a lower inci-dence of hepatolithiasis and a higher infection of HBV.2.Preoperative serum CA19-9 negative ICC had better prognosis than CA19-9 positive.It is usually earlier in TNM classification,less lymph nodes metastasis and less prone to nerve invasion in CA19-9negative ICC.3.Vascular invasion,lymph nodes metastasis and preoperative serum CA125 positive(>35U/m L)are independent prognostic factors of postoperative survival in patients with CA19-9 negative ICC.Preop-erative serum CA125 could be used as a prognostic predictive marker for patients with CA19-9 negative ICC,and help to providing prognosis reference for resectable tumors.