Survival outcomes and progonostic factors of extrahepatic cholangiocarcinoma patients following surgical resection: Adjuvant therapy is a favorable prognostic factor

Abstract

This study was conducted to investigate survival and prognostic factors for extrahepatic cholangiocarcinoma (ECC) following surgical resection and evaluate the effects of postoperative adjuvant therapy (AT) on overall survival (OS). We retrospectively collected clinical and pathological data between March, 2008 and December, 2013. The Kaplan-Meier method and the COX regression model were used to evaluate the OS and prognostic factors of 105 postoperative ECC patients, of whom 32 had received AT. The patients were stratified into seven risk subgroups and the survival rates were compared within each subgroup between patients who received AT and those who did not. The results demonstrated a median OS of 17.6 months, with 1- and 3-year survival rates of 67.9 and 19.5%, respectively, for the entire cohort. On univariate analysis, preoperative cholangitis, non-R0 surgical margins, poor differentiation grade, stage 3/4 and lymphatic metastasis were identified as adverse prognostic factors. AT was not significantly associated with improved OS. However, the subgroup analysis revealed that the effect of AT was significant only in the lymphatic metastasis group (median OS, 21.6 vs. 10.4 months; and 3-year OS, 16.6 vs. 0%, respectively; P=0.02). The survival curves of the AT and non-AT groups were significantly different only for node-positive patients. The COX regression model identified lymphatic metastasis, surgical margins and AT as independent prognostic factors for ECC. A negative resection margin may reduce the mortality rate following surgery by 47%. By contrast, lymph node metastasis was associated with a 2.18-fold higher mortality rate for ECC patients. Postoperative AT contributed to a 0.45-fold mortality rate compared to non-AT ECC patients. Therefore, we concluded that AT is a favorable prognostic factor for ECC patients and it may prolong the survival of patients with lymphatic metastasis. Our data suggest that postoperative AT should be recommended for node-positive ECC patients.

American Radium Society (ARS) Appropriate Use Criteria (AUC) for Extrahepatic Cholangiocarcinoma

“…patients with positive surgical margins or positive lymph nodes. [61][62][63][64][65][66] Several meta-analyses support adjuvant therapy for the resected disease. 67,68 A systematic review and meta-analysis including 42,917 patients from 35 clinical studies found that there was a significant improvement in OS with any adjuvant therapy after surgery compared with surgery only (HR = 0.74; 95% CI = 0.67-0.83; P < 0.001).…”

<p>The Significance of Adjuvant Therapy for Extrahepatic Cholangiocarcinoma After Surgery</p>

“…There are several studies investigating the effect of systemic chemotherapy combined with local radiotherapy as a modality of AT for patients after radical surgery. [42][43][44][45][46] Most studies are retrospective and remained controversial, because of the small size, the lack of correction for multiple comparisons, heterogeneity in terms of patients' characteristics and so on. 14 Furthermore, the combined patterns of chemoradiotherapy, the technologies of radiotherapy, and the regimens of chemotherapy have not been confirmed.…”

“…Conversely, a retrospective series of 105 patients with EHCC following surgical resection between March 2008 and December 2013 indicated that AT was not significantly associated with improved OS (HR=0.87, 95% CI, 0.52-1.44, P=0.57). 42 In the study, a total of 32 patients received AT (18 patients chemotherapy, 11 patients radiotherapy, and 3 patients chemoradiotherapy). On subgroup analysis, the patients with pathological lymphatic metastasis demonstrated AT group had a better survival than non-adjuvant therapy group (median OS, 21.6 months vs 10.4 months; and 3-year OS, 16.6% vs 0%, respectively, P=0.02).…”

Expression of Lamininγ2 in Extrahepatic Cholangiocarcinoma Tissues and its Influence on Tumor Invasion and Metastasis

“…Extrahepatic cholangiocarcinoma (EHCC), which is a kind of malignant tumor derived from the extrahepatic biliary epithelial cells with high malignant severity and recessive attack, is generally treated with surgeries (Pattanathien et al, 2013;Huai et al, 2014). However, the recurrence is extremely high due to the invasion and metastasis in the early stage of EHCC, which severely threatens patients' prognosis (Yang et al, 2014).…”