{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:49:47Z","timestamp":1791917387592,"version":"4.3.4"},"reference-count":14,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Baseline serum carbohydrate antigen (CA) 19\u20109 and carcinoembryonic antigen (CEA) levels may predict prognosis among patients undergoing resection for gallbladder cancer (GBC), yet the prognostic utility of the combination of the two markers has not been well established. In addition, the prognostic significance of elevated preoperative CA19\u20109 levels that normalize after GBC resection is currently unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing resection of GBC between 2002 and 2021 were identified using an international, multi\u2010institutional database. The association of preoperative CA19\u20109 and CEA levels with recurrence\u2010free survival (RFS) following GBC resection was assessed. The negative predictive value (NPV) of normal vs. normalized (high preoperative\/low postoperative levels) CA19\u20109 levels relative to the development of recurrence within 1 year after GBC resection was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 194 patients who underwent resection of GBC, median preoperative CA19\u20109 and CEA levels were 18.8\u2009U\/mL (IQR 7.0\u201388.0) and 2.2\u2009ng\/mL (IQR 1.3\u20133.8), respectively. A total of 92 (47.4%) and 67 (34.5%) patients had elevated CA19\u20109 (&gt;\u200920\u2009U\/mL) and CEA (&gt;\u20093\u2009ng\/mL) levels before GBC resection, respectively. Individuals with low CA19\u20109\/low CEA had the most favorable 3\u2010year RFS (74.5%) after GBC resection followed by individuals with either high CA19\u20109 (high CA19\u20109\/low CEA: 41.6%) or high CEA (low CA19\u20109\/high CEA: 60.9%) levels, whereas patients with high CA19\u20109\/high CEA had the worst 3\u2010year RFS (21.5%) following GBC resection (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Patients with normal preoperative CA19\u20109 levels had better 3\u2010year RFS than patients with high preoperative CA19\u20109 levels that normalized after resection (74.6% vs. 51.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.03). While the NPV of normal preoperative CA19\u20109 levels relative to the development of recurrence within 1 year after GBC resection was 94.7%, the NPV of normalized CA19\u20109 decreased to 70% at 1\u2010year post\u2010resection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Elevation of both preoperative CA19\u20109 and CEA levels portended poor prognosis following resection of GBC. Normalization of postoperative CA19\u20109 levels after GBC resection was still associated with elevated risk of recurrence. While preoperative tumor markers can accurately predict prognosis following resection for GBC, evaluation of traditional tumor markers may not be appropriate markers of occult recurrent disease in the postoperative setting. Better markers are needed to monitor for recurrence following resection of GBC.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.70024","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T09:59:33Z","timestamp":1751277573000},"page":"497-502","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Recurrence After Gallbladder Cancer Resection: Prognostic Impact of CA19\u20109 and CEA Levels at Baseline and During Surveillance"],"prefix":"10.1002","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3676-9263","authenticated-orcid":false,"given":"Diamantis I.","family":"Tsilimigras","sequence":"first","affiliation":[{"name":"Department of Surgery Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odysseas P.","family":"Chatzipanagiotou","sequence":"additional","affiliation":[{"name":"Department of Surgery Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ruzzenente","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Verona Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Aucejo","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Surgery Institute, Department of Hepato\u2010pancreato\u2010biliary and Liver Transplant Surgery Cleveland Clinic Foundation Cleveland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo P.","family":"Marques","sequence":"additional","affiliation":[{"name":"Department of Surgery Curry Cabral Hospital Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Bandovas","sequence":"additional","affiliation":[{"name":"Department of Surgery Curry Cabral Hospital Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Hugh","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Sydney, School of Medicine Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazim","family":"Bhimani","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Sydney, School of Medicine Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3591-8925","authenticated-orcid":false,"given":"Shishir K.","family":"Maithel","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Winship Cancer Institute Emory University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Kitago","sequence":"additional","affiliation":[{"name":"Department of Surgery Keio University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itaru","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Surgery Yokohama City University School of Medicine Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7994-9870","authenticated-orcid":false,"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[{"name":"Department of Surgery Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"99","article-title":"Gallbladder Cancer: Epidemiology and Outcome","volume":"6","author":"Hundal R.","year":"2014","journal-title":"Clinical Epidemiology"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.21683"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.21141"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-09108-y"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-022-11937-y"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2016.05.016"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v14.i11.1272"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2023.0035"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-020-07334-x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1477-2574.2009.00149.x"},{"issue":"1","key":"e_1_2_8_12_1","first-page":"54","article-title":"Reference Values and Biological Variation for Tumor Marker CA 19\u20109 in Serum for Different Lewis and Secretor Genotypes and Evaluation of Secretor and Lewis Genotyping in a Caucasian Population","volume":"45","author":"Vestergaard E. M.","year":"1999","journal-title":"Clinical Chemistry"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11699"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2200075"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-31051-7"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70024","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T10:12:49Z","timestamp":1758622369000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":14,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/jso.70024"],"URL":"https:\/\/doi.org\/10.1002\/jso.70024","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,30]]},"assertion":[{"value":"2025-03-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}