Prediction of Multiple Serum Tumor Markers in Hepatolithiasis Complicated with Intrahepatic Cholangiocarcinoma

Objective: To evaluate the predictive value of multiple serum tumor markers in hepatolithiasis complicated with intrahepatic cholangiocarcinoma (hepatolithiasis-associated cholangiocarcinoma, HL-CCA). Methods: From January 2010 to December 2020, three hundred eighty-five hepatolithiasis patients in Zhoukou Central Hospital were retrospectively analyzed, among them thirty patients complicated with intrahepatic cholangiocarcinoma. The levels of serum AFP, CA125, CA19-9, CA242, and CEA in hepatolithiasis or HL-CCA were measured. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic effects of single or combined detection of the five tumor markers for HL-CCA. Results: The level of AFP was insignificantly different between the hepatolithiasis and HL-CCA (P=0.730). CA125, CA19-9, CA242 and CEA were elevated in HL-CCA. The area under ROC curves (AUCs) of the single detection of serum CA125, CA19-9, CA242 and CEA were all more than 0.5. The maximum AUC occurred in CA19-9. The AUC of AFP was slightly higher than 0.5, but the level of serum AFP was insignificantly different between hepatolithiasis and HL-CCA. The single detection of AFP was not of great significance to the differential diagnosis. The optimal cut-off values of CA125, CA19-9, CA242, and CEA were 104.09 kU/L, 383.28 U/mL, 152.56 kU/L, 6.29 ng/mL. The diagnostic effect of CA19-9 was the highest one for differential diagnosis between hepatolithiasis and HL-CCA. With reference to CA19-9 >383.28 U/mL, the sensitivity and specificity of the single detection were 80.00% and 82.61% respectively, and the AUC was 0.883. The diagnostic effect of CEA was secondary toward CA19-9. With reference to CEA >6.29 ng/mL, the sensitivity and specificity of the single detection were 66.67% and 83.76% respectively, and the AUC was 0.814. Conclusion: Serum CA19-9 maybe the effective tumor marker in the diagnosis of HL-CCA, and measurement of combined serum tumor markers can help in the detection of HL-CCA.

Automated summary

This study found that serum CA19-9 may be an effective tumor marker in the diagnosis of HL-CCA, with high sensitivity and specificity in the differential diagnosis between hepatolithiasis and HL-CCA. Combined detection of multiple serum tumor markers can improve the detection of HL-CCA.