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Prognostic Factors After Surgical Resection for Intrahepatic, Hilar, and Distal Cholangiocarcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prognosis of patients with cholangiocarcinoma is unsatisfactory. Therefore, evaluation of prognostic factors and establishment of new therapeutic strategies are needed to improve their long-term survival. The aim of this study was to identify useful prognostic factors for patients with intrahepatic, hilar, and distal cholangiocarcinoma.

Materials and Methods

Records of 127 patients with cholangiocarcinoma (21 with intrahepatic cholangiocarcinoma, 50 with hilar cholangiocarcinoma, and 56 with distal cholangiocarcinoma) who underwent surgical resection were reviewed retrospectively. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate analysis.

Results

For all 127 patients, overall 1-, 3-, 5-year survival rates were 80, 51, and 40%, respectively. Univariate analysis revealed that adjuvant chemotherapy (P = .049), tumor differentiation (P = .014), lymph node metastasis (P < .001), surgical margin status (P < .001), UICC pT factor (P < .001), and UICC stage (P < .001) were associated significantly with survival. UICC pT factor (P = .007), adjuvant chemotherapy (P = .009), surgical margin status (P = .012), and lymph node metastasis (P = .014) remained independently associated with long-term survival by multivariate analysis. The 5-year survival rates of patients with or without positive surgical margins were 13 and 49%, respectively. The 5-year survival rates of patients treated with or without adjuvant chemotherapy were 47 and 36%, respectively.

Conclusions

R0 resection and adjuvant chemotherapy may be mandatory to achieve long-term survival for patients with cholangiocarcinoma.

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References

  1. Khan SA, Taylor-Robinson SD, Toledano MB, Beck A, Elliott P, Thomas HC. Changing international trends in mortality rates for liver, biliary and pancreatic tumors. J Hepatol. 2002;37:806–13.

    Article  PubMed  Google Scholar 

  2. Furuse J. Postoperative adjuvant treatments for biliary tract cancer. J Hepatobiliary Pancreat Surg. 2008;15:463–7.

    Article  PubMed  Google Scholar 

  3. Nakeeb A, Pitt HA, Sohn TA, Coleman J, Abrams RA, Piantadosi S, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg. 1996;22:463–75.

    Article  Google Scholar 

  4. Shimada K, Sano T, Sakamoto Y, Esaki M, Kosuge T, Ojima H. Surgical outcomes of the mass-forming plus periductal infiltrating types of intrahepatic cholangiocarcinoma: a comparative study with the typical mass-forming type of intrahepatic cholangiocarcinoma. World J Surg. 2007;31:2016–22.

    Article  PubMed  Google Scholar 

  5. Konstadoulakis MM, Roayaie S, Gomatos IP, Labow D, Fiel MI, Miller CM, et al. Fifteen-year, single-center experience with the surgical management of intrahepatic cholangiocarcinoma: operative results and long-term outcome. Surgery. 2008;143:366–74.

    Article  PubMed  Google Scholar 

  6. Uenishi T, Kubo S, Yamazaki O, Yamada T, Sasaki Y, Nagano H, et al. Indications for surgical treatment of intrahepatic cholangiocarcinoma with lymph node metastases. J Hepatobiliary Pancreat Surg. 2008;15:417–22.

    Article  PubMed  Google Scholar 

  7. Nakagohri T, Kinoshita T, Konishi M, Takahashi S, Gotohda N. Surgical outcome and prognostic factors in intrahepatic cholangiocarcinoma. World J Surg. 2008;32:2675–80.

    Article  PubMed  Google Scholar 

  8. Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Nicoli P, et al. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg. 2009;33:1247–54.

    Article  PubMed  Google Scholar 

  9. Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakamura H, et al. Gemcitabine-based adjuvant chemotherapy improves survival after aggressive surgery for hilar cholangiocarcinoma. J Gastrointest Surg. 2009;13:1470–9.

    Article  PubMed  Google Scholar 

  10. Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nimura Y, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci. 2010;17:449–54.

    Article  PubMed  Google Scholar 

  11. Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, et al. Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. J Hepatobiliary Pancreat Sci. 2010;17:455–62.

    Article  PubMed  Google Scholar 

  12. Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, et al. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asian experience. J Hepatobiliary Pancreat Sci. 2010;17:476–89.

    Article  PubMed  Google Scholar 

  13. Unno M, Katayose Y, Rikiyama T, Yoshida H, Yamamoto K, Morikawa T, et al. Major hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2010;17:463–9.

    Article  PubMed  Google Scholar 

  14. Sakamoto Y, Kosuge T, Shimada K, Sano T, Ojima H, Yamamoto J, et al. Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins. Surgery. 2005;37:396–402.

    Article  Google Scholar 

  15. Murakami Y, Uemura K, Hayashidani Y, Sudo T, Hashimoto Y, Ohge H, et al. Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma. J Surg Oncol. 2007;95:207–12.

    Article  PubMed  Google Scholar 

  16. Ebata T, Nagino M, Nishio H, Igami T, Yokoyama Y, Nimura Y. Pancreatic and duodenal invasion in distal bile duct cancer: paradox in the tumor classification of the American Joint Committee on Cancer. World J Surg. 2007;31:2008–15.

    Article  PubMed  Google Scholar 

  17. Woo SM, Ryu JK, Lee SH, Yoo JW, Park JK, Kim YT, et al. Recurrence and prognostic factors of ampullary carcinoma after radical resection: comparison with distal extrahepatic cholangiocarcinoma. Ann Surg Oncol. 2007;14:3195–201.

    Article  PubMed  Google Scholar 

  18. Hong SM, Pawlik TM, Cho H, Aggarwal B, Goggins M, Hruban RH, et al. Depth of tumor invasion better predicts prognosis than the current American Joint Committee on Cancer T classification for distal bile duct carcinoma. Surgery. 2009;146:250–7.

    Article  PubMed  Google Scholar 

  19. Murakami Y, Uemura K, Hayashidani Y, Sudo T, Ohge H, Sueda T. Pancreatoduodenectomy for distal cholangiocarcinoma: prognostic impact of lymph node metastasis. World J Surg. 2007;31:337–42.

    Article  PubMed  Google Scholar 

  20. Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakamura H, et al. Adjuvant gemcitabine plus S-1 chemotherapy improves survival after aggressive surgical resection for advanced biliary carcinoma. Ann Surg. 2009;250:950–6.

    Article  PubMed  Google Scholar 

  21. Murakami Y, Uemura K, Hayasidani Y, Sudo T, Hashimoto Y, Ohge H, et al. Indication for postoperative adjuvant therapy in biliary carcinoma based on analysis of recurrence and survival after surgical resection. Dig Dis Sci. 2009;54:1360–4.

    Article  PubMed  CAS  Google Scholar 

  22. Sobin LH, Gospodarowicz MK, Wittekind C, eds. International Union Against Cancer (UICC): TNM classification of malignant tumors, 7th edn. New York: Wiley-Blackwell; 2010.

    Google Scholar 

  23. DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007;245:755–62.

    Article  PubMed  Google Scholar 

  24. Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Capelli P, et al. Does intrahepatic cholangiocarcinoma have better prognosis compared to perihilar cholangiocarcinoma? J Surg Oncol. 2010;101:111–5.

    PubMed  Google Scholar 

  25. Nakagohri T, Asano T, Kinoshita H, Kenmochi T, Urashima T, Miura F, et al. Aggressive surgical resection for hilar-invasive and peripheral intrahepatic cholangiocarcinoma. World J Surg. 2003;27:289–93.

    Article  PubMed  Google Scholar 

  26. Gerhards MF, van Gulik TM, González González D, Rauws EA, Gouma DJ. Results of postoperative radiotherapy for resectable hilar cholangiocarcinoma. World J Surg. 2003;27:173–9.

    PubMed  Google Scholar 

  27. Hughes MA, Frassica DA, Yeo CJ, Riall TS, Lillemoe KD, Cameron JL,et al. Adjuvant concurrent chemoradiation for adenocarcinoma of the distal common bile duct. Int J Radiat Oncol Biol Phys. 2007;68:178–82.

    Article  PubMed  CAS  Google Scholar 

  28. Serafini FM, Sachs D, Bloomston M, Carey LC, Karl RC, Murr MM, et al. Location, not staging, of cholangiocarcinoma determines the role for adjuvant chemoradiation therapy. Am Surg. 2001;67:839–44.

    PubMed  CAS  Google Scholar 

  29. Sagawa N, Kondo S, Morikawa T, Okushiba S, Katoh H. Effectiveness of radiation therapy after surgery for hilar cholangiocarcinoma. Surg Today. 2005;35:548–52.

    Article  PubMed  Google Scholar 

  30. Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, et al. Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer. 2002;95:1685–95.

    Article  PubMed  Google Scholar 

  31. Penz M, Kornek GV, Raderer M, Ulrich-Pur H, Fiebiger W, Lenauer A, et al. Phase II trial of two-weekly gemcitabine in patients with advanced biliary tract cancer. Ann Oncol. 2001;12:183–6.

    Article  PubMed  CAS  Google Scholar 

  32. André T, Tournigand C, Rosmorduc O, Provent S, Maindrault-Goebel F, Avenin D, et al. GERCOR Group. Gemcitabine combined with oxaliplatin (GEMOX) in advanced biliary tract adenocarcinoma: a GERCOR study. Ann Oncol. 2004;15:1339–43.

    Article  PubMed  Google Scholar 

  33. Patt YZ, Hassan MM, Aguayo A, Nooka AK, Lozano RD, Curley SA, et al. Oral capecitabine for the treatment of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma. Cancer. 2004;101:578–86.

    Article  PubMed  CAS  Google Scholar 

  34. Ueno H, Okusaka T, Ikeda M, Takezako Y, Morizane C. Phase II study of S-1 in patients with advanced biliary tract cancer. Br J Cancer. 2004;91:1769–74.

    Article  PubMed  CAS  Google Scholar 

  35. Sasaki T, Isayama H, Nakai Y, Ito Y, Kogure H, Togawa O, et al. Multicenter, phase II study of gemcitabine and S-1 combination chemotherapy in patients with advanced biliary tract cancer. Cancer Chemother Pharmacol. 2010;65:1101–7.

    Article  PubMed  CAS  Google Scholar 

  36. Todoroki T, Ohara K, Kawamoto T, Koike N, Yoshida S, Kashiwagi H, et al. Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma. Int J Radiat Oncol Biol Phys. 2000;46:581–7.

    Article  PubMed  CAS  Google Scholar 

  37. Cheng Q, Luo X, Zhang B, Jiang X, Yi B, Wu M. Predictive factors for prognosis of hilar cholangiocarcinoma: postresection radiotherapy improves survival. Eur J Surg. Oncol. 2007;33:202–7.

    Article  PubMed  CAS  Google Scholar 

  38. Chen XP, Lau WY, Huang ZY, Zhang ZW, Chen YF, Zhang WG, et al. Extent of liver resection for hilar cholangiocarcinoma. Br J Surg. 2009;96:1167–75.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

    Yoshiaki Murakami MD, Kenichiro Uemura MD, Takeshi Sudo MD, Yasushi Hashimoto MD, Akira Nakashima MD, Naru Kondo MD, Ryutaro Sakabe MD, Hiroki Ohge MD & Taijiro Sueda MD

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  1. Yoshiaki Murakami MD
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  2. Kenichiro Uemura MD
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  3. Takeshi Sudo MD
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  4. Yasushi Hashimoto MD
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  5. Akira Nakashima MD
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  6. Naru Kondo MD
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  7. Ryutaro Sakabe MD
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  8. Hiroki Ohge MD
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  9. Taijiro Sueda MD
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Correspondence to Yoshiaki Murakami MD.

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Murakami, Y., Uemura, K., Sudo, T. et al. Prognostic Factors After Surgical Resection for Intrahepatic, Hilar, and Distal Cholangiocarcinoma. Ann Surg Oncol 18, 651–658 (2011). https://doi.org/10.1245/s10434-010-1325-4

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  • DOI: https://doi.org/10.1245/s10434-010-1325-4

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