Prognostic factors in resectable cholangiocarcinoma patients: Carcinoembryonic antigen, lymph node, surgical margin and chemotherapy

Table 1 Baseline characteristics of 263 resectable cholangiocarcinoma patients n (%)

Age, yr
mean ± SD	59.0 ± 8.9
Range	35-80
Male	181 (69.6)
DM	19 (6.5)
BMI (mean ± SD), kg/m2
< 18.5	23 ± 8.7
18.5-22.9	127 ± 48.3
23-24.9	47 ± 17.9
25-29.9	48 ± 18.3
≥ 30	13 ± 4.9
Not available	5 ± 1.9
Clinical manifestation
Abdominal pain	164 (62.4)
Jaundice	54 (20.5)
Fever	6 (2.3)
Cholangitis	4 (1.5)
Weight loss	1 (0.4)
Asymptomatic	17 (6.5)
Hepatomegaly	153 (58.2)
Total bilirubin (mg/dL)
< 10	213 (81.0)
≥ 10	50 (19.0)
Cholesterol (mg/dL)
< 200	168 (63.9)
≥ 200	95 (36.1)
Albumin (g/dL)
< 3	42 (16.0)
≥ 3	220 (83.7)
ALT (U/L)
< 30	46 (17.5)
≥ 30	151 (82.5)
AST (U/L)
< 30	25 (9.5)
≥ 30	238 (90.5)
ALP (U/L)
< 100	82 (31.2)
≥ 100	180 (68.5)
CA 19-9 (U/mL)
< 35	108 (41.1)
≥ 35	148 (56.3)
CEA (ng/mL)
< 2.5	65 (24.7)
≥ 2.5	183 (69.6)
Receiving adjuvant chemotherapy
Yes	138 (52.5)
No	125 (47.5)

CA 19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; ALT: Alanine transaminase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; BMI: Body mass index; DM: Diabetes mellitus.

Table 2 Tumor data of 263 resectable cholangiocarcinoma n (%)

Tumor location
Intrahepatic	166 (63.1)
Perihilar	91 (34.6)
Distal	6 (2.3)
AJCC staging
0	11 (4.2)
1	37 (14.1)
2	54 (20.5)
3	89 (33.8)
4	72 (27.4)
pT stage
0	10 (3.8)
1	47 (17.9)
2	85 (32.3)
3	95 (36.1)
4	25 (9.5)
pN stage
0	167 (63.5)
1	96 (36.5)
Tumor grading
Well diff	198 (75.3)
Moderate diff	14 (5.3)
Not available	51 (19.4)
Margin surgical resection
Free	134 (51.0)
Not free	129 (49.0)

AJCC: American Joint Committee on Cancer; pN: Pathologic node; pT: Pathologic tumor.

Table 3 Differences of survival time among significant variable factors when analyzed by univariate analysis

Variable	Median survival (mo)	95%CI	P value
Albumin (g/dL)			0.04
< 3	12.8	7.1-18.4
≥ 3	19.1	14.6-23.5
CEA (ng/mL)			0.02
< 2.5	27.7	14.1-41.3
≥ 2.5	16.5	13.0-20.0
AJCC staging			< 0.001
0	Not reached
1	Not reached
2	23.5	16.9-30.1
3	12.8	10.6-15.1
4	12.5	9.3-15.7
Tumor grading			0.01
Well differentiated	17.9	12.6-23.2
Moderate differentiated	7.7	0.0-21.7
Margin in resection group			0.001
Negative	26.7	19.6-33.8
Positive	14.1	11.9-16.4
pT stage			< 0.001
0	Not reached
1	28.6	23.1-34.1
2	19.9	12.9-26.9
3	12.8	9.4-16.3
4	15.5	9.9-21.1
pN stage			< 0.001
0	25.1	20.0-30.1
1	10.0	6.7-13.3
Receiving adjuvant chemotherapy			0.01
Yes	21.6	16.9-26.4
No	13.4	10.7-16.2

CEA: Carcinoembryonic antigen; AJCC: American Joint Committee on Cancer. pN: Pathologic node; pT: Pathologic tumor.

Table 4 Significant prognostic factors by multivariate analysis

Variable	HR	95%CI	P value
Serum CEA (< 2.5 ng/mL ≥ 2.5 ng/mL)	1.68	1.05-2.66	0.027
Lymph node metastasis (yes vs no)	2.27	1.24-4.12	0.007
Receiving adjuvant chemotherapy (yes vs no)	0.71	0.49-1.02	0.067
Surgical margin (negative vs positive)	0.72	0.49-1.06	0.094

CEA: Carcinoembryonic antigen; HR: Hazard ratio.