Cholestasis is the main determinant of abnormal CA 19-9 levels in patientswith liver cirrhosis

Background/Aims: Altered CA19-9 levels are commonly found in patients with liver cirrhosis though a clear explanation for this finding has not yet bee n given. The aim of this study was to investigate whether CA19-9 levels mig ht be related to alterations in biochemical parameters and/or to functional impairment in cirrhotic patients with and without hepatocellular carcinoma . Methods: We studied 126 patients with liver cirrhosis, 60 of whom also ha d hepatocellular carcinoma. CA19-9 values were related to clinical, biochem ical and functional parameters. In half of the patients CA19-9 levels were related to the monoethylglycinexylidide test, which is a dynamic liver func tion test. Results: In more than half the cases CA19-9 values were above the upper lim it. Liver function worsening as assessed by Child-Pugh's score and monoethy lglycinexylidide test did not seem to influence the alteration of the marke r. By contrast, in univariate analysis CA19-9 correlated with aminotransfer ases, gamma-glutamyltransferase and alkaline phosphatase. Multivariate anal ysis showed that besides alkaline phosphatase also the presence of hepatoce llular carcinoma might influence the alteration of CA19-9, although the mar ker was of no use for the diagnosis of liver cancer in patients with altere d though not diagnostic alpha-fetoprotein levels. Conclusions: In our study we confirmed the correlation of CA19-9 levels wit h cholestasis and cytolysis parameters. Moreover, we found no association b etween CA19-9 levels and impaired liver function as assessed by means of th e Child-Pugh's score and the monoethylglycinexylidide test, which is choles tasis-independent and explores liver metabolic and clearance activities. Th e cholestatic picture that characterizes liver cirrhosis might enhance the expression and passage of the marker from the bile to the blood. The additi on of CA19-9 assessment is not useful for the diagnosis of hepatocellular c arcinoma in patients with non-diagnostic levels of alpha-fetoprotein. Cauti on should therefore be used when evaluating CA19-9 in cirrhotic patients wi th cholestasis, since false positive results may occur.