Higher presurgical ratios of carbohydrate antigen 19-9 (CA19-9) to γ-glutamyltransferase (GGT) were associated with tumor recurrence and worse long-term prognosis for patients with distal cholangiocarcinoma (CCA), according to a new study published in the World Journal of Gastrointestinal Surgery.

The study found that patients with preoperative CA19-9/GGT ratios below 0.12 (group 1) had higher 1-, 3-, and 5-year overall survival rates (88.3%, 59.2%, and 48.1%, respectively) compared to patients with a ratio above 0.12 (group 2; 61.0%, 13.6%, and 13.6%, respectively; P =.000).

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Patients in group 1 had longer disease free survival (DFS) (median, 37 months) compared to patients in group 2 (14 months). The 1-, 3-, and 5-year DFS rates were also higher in group 1 than group 2 (84.2%, 51.0%, and 34.8% compared to 52.9%, 20.1%, and 20.1%, respectively; P =.000).

Univariate and multivariate analyses found that in addition to lower ratios of CA19-9/GGT [relative risk (RR)=2.134, 95% CI: 1.319–3.451)], higher degrees of tumor differentiation (RR = 1.695, 95% CI: 1.115–2.576) and a lack of lymphatic metastasis (RR=2.145, 95% CI: 1.404–3.277) were all factors related to a lower risk of tumor recurrence. The same variables were also independent risk factors for long-term survival as well.

A total of 186 patients who were diagnosed with distal CCA and had resection surgery between January 2010 and December 2019 were included in the study analyses. Of these patients, 178 cases received radical resection.

Receiver operating characteristic curve analysis was performed using the CA19-9/GGT ratio obtained from the last blood samples before surgery and 1-year survival in order to determine a cut-off value to divide the patients into 2 groups. A ratio of 0.12 was found to be the best and resulted in an area under the curve of 0.695. Patients with ratios below this value were categorized into group 1 (n=81), and those with ratios above this value were categorized into group 2 (n=105).


Jiang T, Lyu S-C, Zhou L, et al. Carbohydrate antigen 19-9 as a novel prognostic biomarker in distal cholangiocarcinoma. World J Gastrointest Surg. 2021;13(9):1025-1038. doi:10.4240/wjgs.v13.i9.1025