Influence of Hepatic Resection Margin on Recurrence and Survival in Intrahepatic Cholangiocarcinoma

Tamandl, Dietmar; Herberger, Beata; Gruenberger, Birgit; Puhalla, Harald; Klinger, Markus; Gruenberger, Thomas

doi:10.1245/s10434-008-0081-1

Cited by 143 publications

(160 citation statements)

References 26 publications

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“…However, a recent meta-analysis pointed out that the failure to identify any impact of tumor size on OS could be explained by the limited number of patients with small tumors (,5 cm) included in previously studies [21]. Furthermore, more factors were probably involved that would affect the prognosis of ICC after liver resection, and the role of these additional risk variables, in addition to the TNM factors, should be further studied [22][23][24]. Recently, we reported a prognostic nomogram for ICC patients who underwent partial hepatectomy [7].…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Transarterial Chemoembolization Following Liver Resection for Intrahepatic Cholangiocarcinoma Based on Survival Risk Stratification

Wang

Lei

et al. 2015

The Oncologist

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Background. The effectiveness of adjuvant transarterial chemoembolization (TACE) for intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study was performed to identify ICC patients who would benefit from adjuvant TACE. Patients and Methods. The study included 553 patients who underwent hepatectomy for ICC between January 2008 and February 2011 at the Eastern Hepatobiliary Surgery Hospital and who were treated with or without TACE (122 with TACE and 431 without TACE). Survival risk stratification was performed using the established prognostic nomogram (ICC nomogram). The predictive performance was evaluated by concordance index and calibration. The tumor recurrence and overall survival (OS) rates were analyzed by the Kaplan-Meier method before and after propensity score matching (PSM).

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Section: Discussionmentioning

confidence: 99%

Adjuvant Transarterial Chemoembolization Following Liver Resection for Intrahepatic Cholangiocarcinoma Based on Survival Risk Stratification

Wang

Lei

et al. 2015

The Oncologist

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“…Patients with resection generally have the higher recurrence rate. 43,44 In addition, chemotherapy also induces acquired resistance that has been one of the most important clinical problems. 45,46 At such a circumstance, there is now a real and urgent need to focus on developing novel therapeutic strategies for cholangiocarcinoma that would impact in a significant way on clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of active autophagy induces apoptosis and increases chemosensitivity in cholangiocarcinoma

Hou

Dong

Tan

et al. 2011

Laboratory Investigation

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Intrahepatic cholangiocellular carcinomas (ICCs) are usually fatal neoplasms originating from bile duct epithelia. However, many cholangiocarcinoma cells are shown to be resistant to chemotherapeutic drugs, which induce cell apoptosis. The role of autophagy and the therapeutic value of autophagy-associated genes are largely unknown in ICC. Here, we showed that autophagy was activated in nutrient starvation and xenograft cholangiocarcinoma cells. Furthermore, expression of autophagic genes and their autophagic activity were higher in clinical ICC specimens than that in normal cholangiocytes separated by laser capture microdissection. Inhibition of autophagy by autophagy inhibitors or siRNA, cholangiocarcinoma cells showed detention of proliferation and increase of apoptosis during nutrient starvation. In addition, autophagy inhibitor treatment or knockdown of beclin 1 suppressed tumor growth and sensitized ICC cells to chemotherapeutic agent-induced cell death. In conclusion, our data showed that autophagy is activated in ICC, and inactivation of autophagy may lead to cell apoptosis and enhance chemotherapy sensitivity. Intrahepatic cholangiocellular carcinoma (ICC) is a malignant neoplasm originating from epithelium of the biliary tree with high mortality. 1 ICC accounts for 5-30% of all primary liver malignancies, and its incidence has been increasing over the last several decades. 2 The mortality from intrahepatic cholangiocarcinoma is very high, with the 5-year survival rates being o15-20% in most series. 3,4 However, the exact molecular mechanisms of biliary epithelium malignant transformation are not well understood. Despite improved diagnostic and operative techniques, the prognosis of ICC remains poor. 5 Indeed, ICC is a type of cancer highly resistant to conventional antineoplastic medicines, 4 which is partially attributed to the property of insensitivity to cell death induced by cytotoxic agents. It is well known that the avoidance of apoptosis is one of the hallmarks of cancer cells, 6 and that failure to induce apoptosis by anticancer treatments contributes to chemotherapeutic failure and tumor progression. Although autophagy, an alternative caspase-independent cell death program, 7 is thought to be used for cancer treatment, its underlying molecular mechanism is still controversial in antineoplastic therapy and also in tumor progression.Autophagy is a conserved catabolic process by which cells themselves digest their organelles. 8 Autophagy has emerged as a homeostatic mechanism regulating the turnover of long-lived or damaged proteins and organelles, and buffering metabolic stress induced under starvation conditions by recycling intracellular constituents. 9 Autophagosomes engulfing organelles then fuse with lysosomes and mature into autolysosomes. Autophagic processes have been well characterized in yeast, and 430 autophagy-related genes that encode the proteins executing autophagy have been identified in the field of yeast genetics. 6,7 The amino acids and fatty acids generated by autophagic degr...

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“…However, in a small number of patients, extended LN dissection has enhanced the long-term survival after curative surgical treatment [18]. Conversely, some investigators have suggested that patients with LN metastasis should not be considered suitable candidates for extended surgical treatment, because most LN metastases were detected at a great distance from the regional area [19][20][21][22]. Moreover, there is no evidence of the significance of LN dissection based on a definitive controlled study.…”

Section: Introductionmentioning

confidence: 99%

The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics

Morine

Shimada

2015

J Gastroenterol

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Lymph node (LN) metastasis from intrahepatic cholangiocarcinoma (IHCC) might be one of the most important indicators of aggressive surgical resection, yet the value of LN dissection is still controversial. To address this clinical problem, we need to better understand the multidirectional lymphatic outflow from the liver. Although most hepatic lymph flows into the hilar LNs along portal triads, there are also several lymphatic outflows directly communicating with distant areas or the general lymphatic system. Moreover, it has been revealed that LN metastasis spreads to more distal LNs through the hepatoduodenal ligament or other multidirectional lymphatic pathways connected to the general lymphatic system. Therefore, systematic LN dissection might merely be LN sampling in IHCC with LN metastasis. A multidisciplinary strategy focusing on adjuvant treatment after surgery is immediately necessary in these cases. In IHCC without LN metastasis, the accuracy of preoperative imaging assessment of LN metastasis is unsatisfactory and useless for detecting metastatic LNs in clinical settings. Therefore, prophylactic systematic LN dissection for IHCC without preoperative LN swelling is recommended for accurate LN status assessment and reduction of local recurrences. However, this procedure might not offer any clinical benefit according to the results of retrospective comparative studies. In this review, we summarize previous reports regarding lymphatic outflow of the liver and discuss LN dissection for IHCC.

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Influence of Hepatic Resection Margin on Recurrence and Survival in Intrahepatic Cholangiocarcinoma

Abstract: Hepatic resection margin seems to play a minor role in the prognosis of ICC as long as complete tumor clearance can be achieved with a modern liver dissection technique.

Cited by 143 publications

References 26 publications

Adjuvant Transarterial Chemoembolization Following Liver Resection for Intrahepatic Cholangiocarcinoma Based on Survival Risk Stratification

Adjuvant Transarterial Chemoembolization Following Liver Resection for Intrahepatic Cholangiocarcinoma Based on Survival Risk Stratification

Inhibition of active autophagy induces apoptosis and increases chemosensitivity in cholangiocarcinoma

The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics

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