Predictive factors of early recurrence after R0 resection of hilar cholangiocarcinoma: A single institution experience in China

Abstract

Prediction of early postoperative recurrence is of great significance for follow‐up treatment. However, there are few studies available that focus on high‐risk factors of early postoperative recurrence or even the definition the exact time of early recurrence for hilar cholangiocarcinoma. Thus, we aimed to examine the optimal cut‐off value for defining the early in patients with R0 resection of hilar cholangiocarcinoma and to investigate prognostic factors associated with early recurrence. Two hundred and fifty‐eight patients with R0 resection of hilar cholangiocarcinoma between 2000 and 2015 were included. The minimum P value approach was used to define the optimal cut‐off of early recurrence. The prognostic factors associated with early recurrence were investigated. The optimal cut‐off value for dividing patients into early and non‐early recurrence groups after R0 resection of hilar cholangiocarcinoma was 12 months. Sixty‐two patients were recorded as early recurrence, and the remaining 196 patients were labeled as non‐early recurrence. Multivariate logistic regression analysis indicated lymph node metastasis (OR = 2.756, 95% CI 1.409‐5.393; P = 0.003), poor differentiation (OR = 1.653; 95% CI 1.040‐2.632; P = 0.034), increased postoperative CA 19‐9 levels (OR = 1.965, 95% CI 1.282‐3.013; P = 0.002), neutrophil‐to‐lymphocyte ratio > 3.41 (OR = 5.125, 95% CI 2.419‐10.857; P < 0.001) and age > 60 years (OR = 2.018, 95% CI 1.032‐3.947; P = 0.040) were independent determinants of early and non‐early recurrence. Poor differentiation (HR = 2.609, 95% CI 1.600‐4.252; P < 0.001), Bismuth classification type III/IV (HR = 2.510, 95% CI 1.298‐4.852; P = 0.006) and perineural invasion (HR=2.380, 95% CI 1.271‐4.457; P = 0.007) were independent factors of overall survival in the subgroup of patients who developed early recurrence. The optimal cut‐off value for dividing early recurrence after R0 resection of hilar cholangiocarcinoma was 12 months. Tumor differentiation, Bismuth classification, and perineural invasion were independent factors of overall survival in the subgroup of patients with early recurrence. Patients with risk factors should be monitored closely after curative surgery.

Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma

“…The negative impact of locoregional LNM on survival has already been well-established [ 4 , 8 , 9 , 19 , 23 , 25 , 27 , 29 – 36 ]. In the current study, the 5-year DFS of patients without LNM was 55%, compared to 12% of patients with LNM.…”

“…However, in the series of Buettner et al, patients with LNM who underwent a resection still seem to have a better survival after resection compared to patients without surgery [ 36 ]. The pT-stage of the AJCC/UICC TNM-staging system was already identified as a prognostic factor [ 4 , 8 , 9 , 20 , 23 , 29 , 32 ]. In our cohort, pT-stage was a predictor of OS, but had no effect on DFS.…”

“…The 5-year overall survival (OS) ranges from 13 to 42% for resectable pCCA [ 4 ], whereas the median OS of patients with unresectable pCCA is about 12 months with no survivors at 5 years [ 5 ]. The poor survival rates after potentially curative surgery are due to cancer recurrence as a result of the aggressive biological behaviour of pCCA with early hematogenous, lymphatic, and perineural spread of cancer cells [ 6 – 8 ]. Postoperative mortality and morbidity rates vary from 5 to 18% and from 60 to 70%, respectively, which reflect the complexity and technical challenge of the surgical management of pCCA [ 5 ].…”

Prognostic Factors of Hilar Cholangiocarcinoma Patients After Surgical Resection

“…But when doing multi-factor analysis, they do not have difference in statistical tests, which indicates they maybe not independent prognostic factors. But Hai-Jie Hu et.al [26] got the conclusion that Bismuth classification type III/IV was independent factors of overall survival in the subgroup of patients who developed early recurrence.Yunfeng Gao [27] reported that Patients with greater numbers of negative lymph nodes had an increased cancerspecifific survival rate compared to patients with fewer negative lymph nodes. In the study of Felice Giuliante[28],the ratio of positive to negative lymph nodes was the only independent prognostic factor for overall survival but was influenced by the total number of retrieved lymph nodes.In this respect, thorough lymph nodes dissection may be important, and should be prospectively evaluated and studied in the future.…”

Prognostic Factors of Hilar Cholangiocarcinoma Patients After Surgical Resection

“…But when doing multi-factor analysis, they do not have difference in statistical tests, which indicates they maybe not independent prognostic factors. But Hai-Jie Hu et.al [26] got the conclusion that Bismuth classi cation type III/IV was independent factors of overall survival in the subgroup of patients who developed early recurrence.Yunfeng Gao [27] reported that Patients with greater numbers of negative lymph nodes had an increased cancer-speci c survival rate compared to patients with fewer negative lymph nodes. In the study of Felice Giuliante[28],the ratio of positive to negative lymph nodes was the only independent prognostic factor for overall survival but was in uenced by the total number of retrieved lymph nodes.In this respect, thorough lymph nodes dissection may be important, and should be prospectively evaluated and studied in the future.…”