Researchers concluded that the levels of the carbohydrate antigen 19-9 (CA19-9) had a better prognostic performance in patients with intrahepatic cholangiocarcinoma when measured postoperatively, as published in Frontiers in Oncology.

“Patients with elevated preoperative CA19-9 that normalizes after curative resection are associated with comparable long-term survival outcomes compared to those with normal preoperative CA19-9, whereas patients with elevated postoperative CA19-9 are at increased risk of recurrence and death,” the authors wrote.

They found that patients whose CA19-9 levels were persistently increased postoperatively had worse recurrence-free survival (RFS) rates and overall survival (OS) rates than those with normal postoperative CA19-9 (hazard ratio [HR], 2.257, 95% CI, 1.828-2.787, P <.001).

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Both the risk of recurrence and mortality peaked earlier and higher in the group with increased postoperative CA19-9. Also, increased postoperative CA19-9 was identified as an independent risk factor for worse RFS and OS in intrahepatic cholangiocarcinoma by multivariate analyses.

“Measurement of postoperative CA19-9 level may inform an individualized and risk-adjusted surveillance strategy,” the authors said.

In addition, the researchers found that patients with elevated preoperative CA19-9 had worse rates of RFS and OS than those with normal preoperative CA19-9 (HR, 1.613, 95% CI, 1.305-1.993, P <.001), which was in agreement with observations from previous studies.

The study enrolled 511 patients with intrahepatic cholangiocarcinoma (median age, 58 years, 51.7% female). Most (n=378) patients had increased preoperative CA19-9, while 152 patients presented with normal levels of CA19-9.

Of those patients with increased preoperative CA19-9, 105 had levels returning to a normal range after hepatectomy, while 254 showed persistently elevated postoperative CA19-9.

The levels of CA19-9 were measured once a month for the first 3 months after surgery, then at every 3 to 6 months for 2 years, and at 6-month intervals thereafter.


Li H, Feng Y, Liu C, et al. Importance of normalization of carbohydrate antigen 19-9 in patients with intrahepatic cholangiocarcinoma. Front Oncol. 2021;11. doi:10.3389/fonc.2021.780455