Perihilar cholangiocarcinoma (pCCA) is an uncommon malignancy with generally poor prognosis. Surgery is the primary curative treatment; however, the perioperative mortality and morbidity rates are high, with a low 5-year survival rate. Use of preoperative prognostic biomarkers to predict survival outcomes after surgery for pCCA are not well-established currently. This systematic review aimed to identify and summarise preoperative biomarkers associated with survival in pCCA, thereby potentially improving treatment decision-making. The Embase, Medline, and Cochrane databases were searched, and a systematic review was performed using the PRISMA guidelines. English-language studies examining the association between serum and/or tissue-derived biomarkers in pCCA and overall and/or disease-free survival were included. Our systematic review identified 64 biomarkers across 48 relevant studies. Raised serum CA19-9, bilirubin, CEA, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and tumour MMP9, and low serum albumin were most associated with poorer survival; however, the cutoff values used widely varied. Several promising molecular markers with prognostic significance were also identified, including tumour HMGA2, MUC5AC/6, IDH1, PIWIL2, and DNA index. In conclusion, several biomarkers have been identified in serum and tumour specimens that prognosticate overall and disease-free survival after pCCA resection. These, however, require external validation in large cohort studies and/or in preoperatively obtained specimens, especially tissue biopsy, to recommend their use.
肝门部胆管癌是一种预后普遍不良的罕见恶性肿瘤。手术是主要的根治性治疗手段，但其围手术期死亡率和并发症发生率较高，且五年生存率较低。目前，利用术前预后生物标志物预测肝门部胆管癌术后生存结局的方法尚未完善。本系统综述旨在识别并总结与肝门部胆管癌生存相关的术前生物标志物，以期优化临床治疗决策。通过检索Embase、Medline和Cochrane数据库，并遵循PRISMA指南进行系统综述，纳入了探讨肝门部胆管癌患者血清和/或组织来源生物标志物与总生存期和/或无病生存期相关性的英文研究。本系统综述共纳入48项相关研究，识别出64种生物标志物。其中，血清CA19-9、胆红素、CEA、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值及肿瘤MMP9水平升高，以及血清白蛋白水平降低与较差的生存预后最为相关，但各研究采用的临界值差异较大。同时发现多种具有预后意义的分子标志物，包括肿瘤HMGA2、MUC5AC/6、IDH1、PIWIL2及DNA指数。综上所述，已在血清和肿瘤标本中发现多种能够预测肝门部胆管癌切除术后总生存期和无病生存期的生物标志物。然而，这些标志物仍需通过大型队列研究和/或术前获取的标本（特别是组织活检）进行外部验证，方能推荐临床应用。
Systematic Review of Preoperative Prognostic Biomarkers in Perihilar Cholangiocarcinoma
肿瘤(癌症)患者之家