CAC, the combination of carbohydrate antigen 19-9 (CA19-9) and aspartate aminotransferase to lymphocyte ratio index (ALRI), can be a valuable biomarker for the prognosis of patients with intrahepatic cholangiocarcinoma.

According to a new study published in Cancer Management and Research, patients with elevated CAC grades had worse long-term outcomes after hepatectomy.

Haizhou Qiu and the coauthors of the study stated, “Our data suggest that increased CAC grades can be used to stratify patients and help to decide their treatment strategies.”

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Intrahepatic cholangiocarcinoma is a type of cancer with increasing morbidity and a poor prognosis even after surgical resection. It is therefore important to stratify patients and optimize treatment strategies. To be able to do so, effective prognostic biomarkers are of great importance.

Read more about cholangiocarcinoma prognosis

In the present study, a team of researchers led by Wentao Wang, PhD, investigated the prognostic values of CA19-9, ALRI, and their combination in predicting long-term outcomes in patients after hepatectomy.

They retrospectively reviewed 530 patients with intrahepatic cholangiocarcinoma who underwent a hepatectomy between January 2009 and September 2017. During a median follow-up period of 1.5 years, more than half of the patients died (317 of 530) and 381 experienced tumor recurrence.

Using statistical analyses, the researchers found that a lower ALRI, decreased serum levels of CA19-9, and a low CAC grade were associated with better overall survival and disease-free survival. They also found that the number of tumors, whether they invaded the lymph nodes, and the CAC grade were independent prognostic factors for both overall survival and disease-free survival.

The researchers wrote, “CAC grade is an independent risk factor for [overall survival] and [disease-free survival] in patients with [intrahepatic cholangiocarcinoma] after hepatectomy.” They added, “In the future, CAC could help to stratify patients with [intrahepatic cholangiocarcinoma] and guide treatment strategies.”


Qiu H, Liu C, Huang M, Shen S, Wang W. Prognostic value of combined CA19-9 with aspartate aminotransferase to lymphocyte ratio in patients with intrahepatic cholangiocarcinoma after hepatectomy. Cancer Manag Res. 2021;13:5969-5980. doi:10.2147/CMAR.S320380