Survival after surgical resection of distal cholangiocarcinoma: A systematic review and meta-analysis of prognostic factors

Zhou, Yanming; Liu, Shuncui; Wu, Lupeng; Wan, Tao

doi:10.1016/j.asjsur.2015.07.002

Cited by 70 publications

(77 citation statements)

References 45 publications

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“…Tumor differentiation and LN metastases were identified as important predictors of survival in our study, as demonstrated in other studies [2-5,7,12]. In particular, a meta-analysis conducted by Zhou et al [13] revealed that LN metastasis was associated with shorter OS (risk ratio, 2.35; 95% confidence interval, 1.89 to 2.93; p < 0.0001). Most studies included in this meta-analysis reported that LN metastasis has a powerful negative effect on survival.…”

Section: Discussionsupporting

confidence: 86%

“…A positive resection margin has been considered as an adverse prognostic factor in some studies [6,7,11,13]; however, its prognostic impact has not been fully determined because of inconsistent results among studies and diverse definitions. Incidences of a positive resection margin in EHBD cancer after curative resection can vary from 10% to as high as 70%, which can be explained by differences between surgeons regarding the principle of the operation or the definition of a positive resection margin, such as whether to include carcinoma in situ [15-19].…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Kim

Chie

et al. 2017

Cancer Res Treat

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PurposeThis study was conducted to evaluate the long-term outcome in patients undergoing pancreaticoduodenectomy (PD) followed by adjuvant chemoradiotherapy for distal cholangiocarcinoma (DCC) in a high-volume center and to identify the prognostic impact of clinicopathologic factors.Materials and MethodsA total of 132 consecutive patients who met the inclusion criteria were retrieved from the institutional database from January 1995 to September 2009. All patients received adjuvant treatments at a median of 45 days after the surgery. Median follow-up duration was 57 months (range, 6 to 225 months) for all patients and 105 months for survivors (range, 13 to 225 months).ResultsThe 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 70.7%, 55.7%, 49.4%, and 48.1%, respectively. Univariate analysis revealed poorly differentiated (P/D) tumors and lymph node (LN) metastasis were significantly associated with DMFS and OS. Additionally, preoperative carbohydrate antigen 19-9 level was significantly correlated with DFS, LRRFS, and DMFS. Upon multivariate analysis for OS, P/D tumors (p=0.015) and LN metastasis (p=0.003) were significant prognosticators that predicted inferior OS. Grade 3 or higher late gastrointestinal toxicity occurred in only one patient (0.8%).ConclusionAdjuvant chemoradiotherapy after PD for DCC is an effective and tolerable strategy without significant side effects. During long-term follow-up, we found that prognosis of DCC was mainly influenced by histologic differentiation and LN metastasis. For patients with these risk factors, further research should focus on improving adjuvant strategies as well as other treatment approaches.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Kim

Chie

et al. 2017

Cancer Res Treat

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“…Several factors, including pancreatic invasion, lymph node metastasis, resection margin status, tumor grade, lymphatic invasion, perineural invasion, vascular invasion, type of preoperative biliary drainage, and postoperative pancreatic fistula, have been reported to be associated with poor prognostic outcome in patients with DCC who undergo surgical resection [18-22]. However, most of these predictive factors can be determined only after surgery, and some are not objective, and thus they would not improve treatment decision-making or help implement stratification strategies preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Association of Preoperative Platelet-to-Lymphocyte Ratio with Poor Outcome in Patients with Distal Cholangiocarcinoma

et al. 2019

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Background: Several preoperative systemic inflammatory parameters, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and Glasgow Prognostic Score, have been reported to be associated with the prognosis of solid tumors. However, there are conflicting survival data regarding these parameters in cholangiocarcinoma. Objectives: In this study, we performed a retrospective cohort analysis of patients with distal cholangiocarcinoma (DCC) who underwent surgical resection to evaluate the prognostic value of a cluster of preoperative hematological inflammatory parameters for survival. Method: Fifty-three patients with DCC who underwent pancreaticoduodenectomy with curative intent were enrolled. The optimal cutoff values of hematological inflammatory parameters, including the absolute lymphocyte count, NLR, PLR, and LMR, were determined by time-dependent receiver operating characteristic analysis. Results: The univariate analysis for overall survival (OS) of conventional factors and hematological inflammatory parameters identified that portal vein invasion and PLR had p values of ≤0.1. The univariate analysis for disease-free survival (DFS) identified that lymph node metastasis, PLR, lymphocyte count, and number of positive lymph nodes (≥3) had p values of ≤0.1. These factors were incorporated into the full model and variables were selected using the backward stepwise method. The multivariate analysis identified portal vein invasion and high PLR as independent prognostic factors for OS (p = 0.033 and 0.039, respectively) and high PLR and number of positive lymph nodes (≥3) as independent prognostic factors for DFS (p = 0.016 and 0.004, respectively). Conclusions: Preoperative PLR assessment may be useful for detecting high-risk DCC patients undergoing surgical resection for aggressive adjuvant therapy.

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“…Likewise, patients with early-stage HCC can be offered a potentially curative approach if the tumors are found to be resectable [7]. In patients with CCC, who generally have a poor prognosis, surgical resection again represents the only potential strategy to permanently eradicate the disease [8–10]. …”

Section: Introductionmentioning

confidence: 99%

Austrian consensus guidelines on imaging requirements prior to hepatic surgery and during follow-up in patients with malignant hepatic lesions

Tamandl

Ba‐Ssalamah

Böhm

et al. 2018

Wien Klin Wochenschr

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SummaryRapid advances in imaging technology have improved the detection, characterization and staging of colorectal liver metastases, hepatocellular carcinoma and cholangiocarcinoma. A variety of imaging modalities are available and play a pivotal role in the work-up of patients, particularly as imaging findings determine resectability. Surgery often represents the only measure that can render long-term survival possible. Imaging is also indispensable for the assessment of responses to neoadjuvant treatment and for the detection of recurrence. At a consensus meeting held in June 2017 in Vienna, Austria, Austrian experts in the fields of surgery and radiology discussed imaging requirements prior to and after hepatic surgery for malignant liver lesions. This consensus was refined by online voting on a total of 47 items. Generally, the degree of consensus was high. The recommendations relate to the type of preferred preoperative imaging modalities, technical settings with respect to computed tomography and magnetic resonance imaging, use of contrast agents, reporting, postoperative follow-up, and long-term follow-up. Taking local resources into account, these consensus recommendations can be implemented in daily clinical practice at specialized centers as well as outpatient diagnostic institutes in Austria.

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Survival after surgical resection of distal cholangiocarcinoma: A systematic review and meta-analysis of prognostic factors

Abstract: In general, prognosis of DCC after resection is poor. R0 resection results in a substantially improved survival and represents one of the most important prognostic variables.

Cited by 70 publications

References 45 publications

Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Association of Preoperative Platelet-to-Lymphocyte Ratio with Poor Outcome in Patients with Distal Cholangiocarcinoma

Austrian consensus guidelines on imaging requirements prior to hepatic surgery and during follow-up in patients with malignant hepatic lesions

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