2 articles which mention CA19-9

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January 2000 • Volume 31 • Number 1

Original Article

Cholangiocarcinoma in patients with primary sclerosing cholangitis: A multicenter case-control study

Naga Chalasani1

Arthur Baluyut1

Ayaaz Ismail2

Atif Zaman3

Gagan Sood4

Reem Ghalib5

T. M. McCashland6

K. Rajender Reddy7

Xaralambos Zervos7

Mann A. Anbari8

Helena Hoen1

Patients with primary sclerosing cholangitis (PSC) have a significantly increased risk of developing cholangiocarcinoma (CCA). Risk factors for developing such a complication are not well defined. We conducted a multicenter, case-control study to determine the risk factors and possible predictors for CCA in patients with PSC. The demographic, clinical, and laboratory features of 26 PSC patients with CCA diagnosed over a 7-year period at eight academic centers were compared with 87 patients with PSC but no CCA (controls). There was no statistically significant difference in demographics, smoking, signs or symptoms or complications of PSC, indices of disease severity (Mayo Risk score or Child-Pugh score), frequency or duration or complications of inflammatory bowel disease (IBD), frequency of biliary surgery, or therapeutic endoscopy between the two groups. Alcohol consumption was significantly associated with CCA in patients with PSC (odds ratio: 2.95; 95% CI: 1.04-8.3). Serum carbohydrate antigen 19-9 (CA 19-9) was significantly higher in patients with CCA than those without (177 ± 89 and 61 ± 58 U/mL, respectively; P = .002). A serum CA 19-9 level > 100 U/mL had 75% sensitivity and 80% specificity in identifying PSC patients with CCA. In conclusion, alcohol consumption was a risk factor for having CCA in PSC patients. The indices of severity of liver disease were not associated with CCA in patients with PSC. Serum CA 19-9 appeared to have good ability to discriminate PSC patients with and without CCA.

(Hepatology 2000;31:7-11.)

Abbreviations

PSC primary sclerosing cholangitis

CCA cholangiocarcinoma

IBD inflammatory bowel disease

ROC receiver operator characteristic

CA 19-9 carbohydrate antigen 19-9, AUC, area under the curve

From the 1Indiana University School of Medicine, Indianapolis, IN; 2Emory University School of Medicine, Atlanta, GA; 3Oregon Health Sciences University, Portland, OR; 4Gagan Sood and the UAB Liver Center, University of Alabama at Birmingham, Birmingham, AL; 5University of Texas at Houston, Houston, TX; 6University of Nebraska Medical Center, Omaha, NE; 7University of Miami Medical Center, Miami, FL; 8Saint Louis University, St Louis, MO.

July 2002 • Volume 56 • Number 1

Original Articles

Detecting cholangiocarcinoma in patients with primary sclerosing cholangitis

Siqueira, MD

E. Schoen, MD

Silverman, MD

i, MD

Mordechai Rabinovitz, MD

L. Weissfeld, MD

Kareem Abu Elmaagd, MD

R. Madariaga, MD

Adam Slivka, MD

Pittsburgh, Pennsylvania

Background: Primary sclerosing cholangitis is a progressive cholestatic liver disease associated with cholangiocarcinoma. Brush cytology and serum tumor markers (carcinoembryonic antigen, carbohydrate antigen 19-9 [CA19-9]) have been used to diagnose cholangiocarcinoma, but there are few data comparing their effectiveness.

Methods: The effectiveness of brush cytology, carcinoembryonic antigen, and CA19-9 for the diagnosis of cholangiocarcinoma was retrospectively studied by review of patients with primary sclerosing cholangitis. Receiver operator curves were used to identify cutoff points for carcinoembryonic antigen and CA19-9.

Results: Of 692 patients with primary sclerosing cholangitis screened, adequate follow-up was obtained in 333, 44 (13%) of whom had a diagnosis of cholangiocarcinoma. Three hundred eighteen brush cytology specimens were obtained in 151 patients; serum carcinoembryonic antigen and CA19-9 levels were obtained in 144 and 55 patients, respectively. The overall sensitivity and specificity of brush cytology were, respectively, 46.4% (95% CI [27.5, 64.5]) and 100% (95% CI [97.2, 100]). A carcinoembryonic antigen >5.2 ng/mL had a sensitivity of 68.0% (95% CI [47.5, 83.9]) and specificity of 81.5% (95% CI [73.9, 87.7]). A CA19-9 >180 U/mL had a sensitivity of 66.7% (95% CI [34.9, 87.7]) and specificity of 97.7% (95% CI [88.2, 99.9]). In the subset of patients in which all 3 tests were obtained, (n = 45, cholangiocarcinoma = 8) the combination of an abnormal carcinoembryonic antigen or CA19-9 had the highest sensitivity: 100% (95% CI [65.1, 100.0]) with a specificity of 78.4% (95% CI [63.1, 89.7]). The combination of a positive brush cytology or an abnormal CA19-9 had a sensitivity and specificity of, respectively, 87.5% (95% CI [50.0, 99.4]) and 97.3% (95% CI [86.2, 99.9]).

Conclusions: Screening patients with primary sclerosing cholangitis for cholangiocarcinoma with CA19-9 and carcinoembryonic antigen is reasonable, but the ideal intervals at which to obtain these tests and the cost-effectiveness require further study. (Gastrointest Endosc 2002;56:40-7.)

Current affiliations: Departments of Medicine and Transplantation Surgery, and the University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.