Defining Early Recurrence of Hilar Cholangiocarcinoma After Curative‐intent Surgery: A Multi‐institutional Study from the US Extrahepatic Biliary Malignancy Consortium

Zhang, Xufeng; Beal, Eliza W.; Chakedis, Jeffery; Chen, Qinyu; Lv, Yi; Ethun, Cecilia G.; Salem, Ahmed; Weber, Sharon M.; Tran, Thuy B.; Poultsides, George A.; Son, Andre Y.; Hatzaras, Ioannis; Jin, Linda X.; Fields, Ryan C.; Buettner, Stefan; Scoggins, Charles R.; Martin, Robert C.G.; Isom, Chelsea A.; Idrees, Kamron; Mogal, Harveshp; Shen, Perry; Maithel, Shishir K.; Schmidt, Carl; Pawlik, Timothy M.

doi:10.1007/s00268-018-4530-0

Cited by 55 publications

(46 citation statements)

References 61 publications

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“…However, median overall survival in our study is in line with published (and partly older) retrospective analyses [18,8,21,23], underscoring the need for new treatment strategies, since no improvement of survival could be detected over the past decades. R0 resection rates for patients amenable to surgery were slightly higher in our study than reported in the literature [7][8][9][10], which might be due to selection bias and/or mandatory multidisciplinary treatment decisions in our center.…”

Section: Discussionsupporting

confidence: 89%

“…Survival and prognosis in patients with CCA in a curative and palliative setting have not profoundly improved in the past years [1,18]. Data on survival rates, prognostic-and risk factors mainly come from retrospective studies similar to the one presented here [7][8][9][19][20][21]. Of note is that a large number of retrospective analyses also included patients being treated back to the early 1990s [7][8][9] or even earlier [19,20,22].…”

Section: Discussionmentioning

confidence: 99%

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Poor Prognosis of Advanced Cholangiocarcinoma: Real-World Data from a Tertiary Referral Center

et al. 2019

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Background: Incidence of cholangiocarcinoma (CCA) in western countries is rising. In the palliative setting, chemotherapy is the only established treatment. The evidence for other treatments including locoregional therapy is low. However, such individual treatments are offered in a realworld setting. The aim of this study is to document the offered treatments and to analyze the survival of patients with unresectable CCA treated at a tertiary referral center. Patients and methods: Data from 220 consecutive patients with CCA treated at a German university cancer center from January 1, 2008, until December 31, 2012. Of those, 105 patients were unresectable. Survival curves were calculated according to the Kaplan-Meier method; log-rank test was applied for survival analysis. Results: Any palliative treatment was beneficial for patients with unresectable CCA when compared to best supportive care (BSC) alone; median OS with BSC was 10 weeks (BSC vs. transarterial chemoembolization [TACE] p = 0.017, HR 0.36; BSC vs. TACE/chemotherapy p < 0.001, HR 0.24; BSC vs. chemotherapy p < 0.001, HR 0.31). Combination of TACE and chemotherapy prolonged overall survival as compared to TACE alone (105 vs. 43 weeks, p = 0.045). Conclusion: Prognosis in advanced stage CCA is still very poor. However, multimodal treatment in palliative patients significantly prolong survival.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Poor Prognosis of Advanced Cholangiocarcinoma: Real-World Data from a Tertiary Referral Center

et al. 2019

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“…In total, 21 patients died within 90 days after surgery and were excluded from the analysis to reduce the impact of postoperative complications when assessing the recurrence rates and calculating the optimal cutoff point for early recurrence. 19,20 The postoperative complication rate after surgery was 44.8% (n = 184), which included 117 patients with CD II or higher complications. Major complications (CD II-III) consisted of bile leakage (n = 28), peritoneal cavity infection (n = 14), lung infection (n = 18), sepsis (n = 4), hemorrhage (n = 13), hepatic failure (n = 18), renal failure (n = 2), stress ulcer (n = 7), and others (n = 13).…”

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

“…Early recurrence after curative surgery has been associated with poor prognosis in hepatic carcinoma. 19,33,34 Zhang et al 19 defined radiologically diagnosed recurrence within 2.5 years after curative surgery as early recurrence in HC patients. The difficulty to achieve negative resection margin for type IV HC renders relatively worse prognosis.…”

Section: Univariate and Multivariate Analysis Of Clinicopathologic Inmentioning

confidence: 99%

“…In keeping with our results, a positive relationship has been shown between N stage and early recurrence for potentially resectable HC. 19 While the pathologic classification of previous studies was mainly based on AJCC 7th edition, in which lymph node metastases were stratified according to the distribution of lymph nodes, our cohort followed the 8th edition of AJCC staging, which uses the number of positive lymph nodes for classification. Similar to our results, lymphovascular invasion has been strongly associated with poor oncological prognosis in type IV HC patients.…”

Section: Univariate and Multivariate Analysis Of Clinicopathologic Inmentioning

confidence: 99%

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Lymphocyte to Monocyte Ratio Predicts Resectability and Early Recurrence of Bismuth-Corlette Type IV Hilar Cholangiocarcinoma

Peng

et al. 2020

Journal of Gastrointestinal Surgery

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Background The objective of our research was to investigate the value of the lymphocyte to monocyte ratio (LMR) and its dynamic changes (LMRc) in predicting tumor resectability and early recurrence of radiologically resectable type IV hilar cholangiocarcinoma (HC). Methods A total of 411 patients with radiologically resectable type IV HC were included. Data on their clinicopathologic characteristics, perioperative features, and survival outcomes were analyzed. Receiver operating characteristic (ROC) analysis was conducted to assess the ability of preoperative LMR (pre-LMR) to predict tumor resectability, and the ability of postoperative LMR (post-LMR) to discriminate between early and late recurrence. Survival curves were calculated using the Kaplan-Meier estimate. Univariate and multivariate logistic regression models were used to identify factors associated with resectability and early recurrence. Results Of 411 patients with potentially curative type IV HC, 254 underwent curative surgery. The optimal cutoff value of pre-LMR as an indicator of resectability was 3.67, and the optimal cutoff value of post-LMR for detecting early recurrence was 4.10. In the multivariate logistic regression model, CA19-9 > 200 U/mL, pre-LMR ≤ 3.67, and tumor size > 3 cm were found to be independent risk factors for poor resectability. Moreover, multivariate analysis showed that LMRc, resection margin, AJCC N stage, and lymphovascular invasion were independent risk factors associated with early recurrence. Discussion Pre-LMR is a valuable indicator of resectability and LMRc is a valuable predictor of early recurrence in patients with curative type IV HC.

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Adjuvant chemoradiotherapy for positive hepatic ductal margin on cholangiocarcinoma

Sugiura

Uesaka

Okamura

et al. 2020

Annals of Gastroent Surgery

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Aim This study evaluated the effects of postoperative adjuvant chemoradiotherapy (A‐CRT) for positive hepatic ductal margin (HM+) in extrahepatic cholangiocarcinoma (EHCC). Methods Patients with EHCC who underwent surgical resection between 2002 and 2014 were included in this retrospective study. For patients with HM+, A‐CRT was conducted. The clinical effect of A‐CRT for HM+ on the survival and recurrence and prognostic factors of EHCC was reviewed. Results Among 340 patients, the hepatic ductal margin was negative in 296 and positive in 44. Of the 44 patients with HM+, 22 received postoperative A‐CRT, and 22 did not. Hepatic stump recurrence occurred in 19 patients. The incidence was significantly higher in patients with HM+ (20%, 9/44) than in those with negative hepatic ductal margin (HM−) (3%, 10/296) ( P < .001). Among the patients with HM+, the incidence was almost identical between the patients with and without A‐CRT: 23% (5/22) in HM+/CRT− and 18% (4/22) in HM+/CRT+ patients ( P = .999). The median survival time was 49 months in HM−, 43 months in HM+/CRT−, and 49 months in HM+/CRT+ patients. The differences were not significant among the groups. A multivariate analysis revealed CA 19‐9 ≥ 300 U/mL, combined vascular resection, histologic grade G2/G3, and lymph node metastasis to be significant prognostic factors. However, the performance of postoperative A‐CRT did not contribute to prolonging survival. Conclusion A‐CRT for HM+ in patients with EHCC did not affect the survival or stump recurrence.

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Defining Early Recurrence of Hilar Cholangiocarcinoma After Curative‐intent Surgery: A Multi‐institutional Study from the US Extrahepatic Biliary Malignancy Consortium

Abstract: Early recurrence of HCCA after curative resection was common (~35.6%). Early recurrence was strongly associated with aggressive tumor characteristics, increased risk of distant metastatic recurrence and a worse long-term survival.

Cited by 55 publications

References 61 publications

Poor Prognosis of Advanced Cholangiocarcinoma: Real-World Data from a Tertiary Referral Center

Poor Prognosis of Advanced Cholangiocarcinoma: Real-World Data from a Tertiary Referral Center

Lymphocyte to Monocyte Ratio Predicts Resectability and Early Recurrence of Bismuth-Corlette Type IV Hilar Cholangiocarcinoma

Adjuvant chemoradiotherapy for positive hepatic ductal margin on cholangiocarcinoma

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