Skip to main content

Advertisement

SpringerLink
Log in

Spread of lymph node metastasis and adjuvant therapy for distal cholangiocarcinoma

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

Lymphatic metastasis is a major route of metastasis in distal cholangiocarcinoma (DCC). The present study aimed to elucidate the pattern of lymph node (LN) metastasis and the effectiveness of LN dissection and postoperative adjuvant chemotherapy in patients with DCC.

Methods

Patients who underwent surgical resection with curative intent for DCC were enrolled. The nomenclature of the LN stations was defined according to the Japanese Society of Hepato-Biliary-Pancreatic Surgery guidelines. Effectiveness of LN dissection of each station was calculated using frequency of LN metastasis to the station and 5-year survival rate of patients with LN metastasis to that station.

Results

Of the 105 patients included in the study, 46 (43.8%) had LN metastasis, and 43 (41.0%) underwent postoperative adjuvant therapy. LN metastasis, serum carbohydrate antigen (CA) 19–9 level > 37 U/mL, and positive bile duct margin were independent risk factors for shorter overall survival (OS). The most common metastatic LN station at surgery was No. 13 (32.7%), followed by No. 12 (19.2%), No. 17 (9.6%), and No. 8 (6.6%). There was no effectiveness of LN dissection of the station No. 8, 14, and 16. Adjuvant chemotherapy was significantly associated with longer OS in patients with LN metastasis but not in those with positive ductal margins or serum CA 19–9 level > 37 U/mL.

Conclusions

Postoperative adjuvant chemotherapy was associated with a better prognosis in patients with DCC and LN metastasis. However, a more effective therapeutic strategy is required to improve the prognosis of patients with other negative prognostic factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Razumilava N, Gores GJ (2014) Cholangiocarcinoma. Lancet 383:2168–2179

    Article  Google Scholar 

  2. Al Mahjoub A, Bouvier V, Menahem B et al (2019) Epidemiology of intrahepatic, perihilar, and distal cholangiocarcinoma in the French population. Eur J Gastroenterol Hepatol 31:678–684

    Article  Google Scholar 

  3. Ercolani G, Dazzi A, Giovinazzo F et al (2015) Intrahepatic, peri-hilar and distal cholangiocarcinoma: three different locations of the same tumor or three different tumors? Eur J Surg Oncol 41:1162–1169

    Article  CAS  Google Scholar 

  4. Andrianello S, Paiella S, Allegrini V et al (2015) Pancreaticoduodenectomy for distal cholangiocarcinoma: surgical results, prognostic factors, and long-term follow-up. Langenbecks Arch Surg 400:623–628

    Article  Google Scholar 

  5. Murakami Y, Uemura K, Hayashidani Y et al (2015) Prognostic impact of lymph node metastasis in distal cholangiocarcinoma. Br J Surg 102:399–406

    Article  Google Scholar 

  6. Li X, Lin H, Sun Y et al (2019) Prognostic significance of the lymph node ratio in surgical patients with distal cholangiocarcinoma. J Surg Res 236:2–11

    Article  Google Scholar 

  7. Chung MJ, Lee KJ, Bang S et al (2011) Preoperative serum CA 19–9 level as a predictive factor for recurrence after curative resection in biliary tract cancer. Ann Surg Oncol 18:1651–1656

    Article  Google Scholar 

  8. Murakami Y, Uemura K, Sudo T et al (2011) Prognostic factors after surgical resection for intrahepatic, hilar, and distal cholangiocarcinoma. Ann Surg Oncol 18:651–658

    Article  Google Scholar 

  9. Kurahara H, Maemura K, Mataki Y et al (2017) Relationship between the surgical margin status, prognosis, and recurrence in extrahepatic bile duct cancer patients. Langenbecks Arch Surg 402:87–93

    Article  Google Scholar 

  10. Chun YS, Pawlik TM, Vauthey JN (2018) 8th edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol 25:845–847. https://doi.org/10.1245/s10434-017-6025-x

    Article  PubMed  Google Scholar 

  11. Hester C, Nassour I, Adams-Huet B et al (2018) Improved survival in surgically resected distal cholangiocarcinoma treated with adjuvant therapy: a propensity score matched analysis. J Gastrointest Surg 22:2080–2087

    Article  Google Scholar 

  12. Bergeat D, Turrini O, Courtin-Tanguy L et al (2018) Impact of adjuvant chemotherapy after pancreaticoduodenectomy for distal cholangiocarcinoma: a propensity score analysis from a French multicentric cohort. Langenbecks Arch Surg 403:701–709

    Article  Google Scholar 

  13. Messina C, Merz V, Frisinghelli M et al (2019) Adjuvant chemotherapy in resected bile duct cancer: a systematic review and meta-analysis of randomized trials. Crit Rev Oncol Hematol 143:124–129

    Article  Google Scholar 

  14. Sasako M, McCulloch P, Kinoshita T et al (1995) New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 82:346–351

    Article  CAS  Google Scholar 

  15. Imamura T, Yamamoto Y, Sugiura T et al (2021) Reconsidering the optimal regional lymph node station according to tumor location for pancreatic cancer. Ann Surg Oncol 28:1602–1611

    Article  Google Scholar 

  16. Miyazaki M, Ohtsuka M, Miyakawa S et al (2015) Classification of biliary tract cancers established by the Japanese society of hepato-biliary-pancreatic surgery 3(rd) English edition. J Hepatobiliary Pancreat Sci 22:181–196

    Article  Google Scholar 

  17. Neoptolemos JP, Moore MJ, Cox TF et al (2012) Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 308:147–156

    Article  CAS  Google Scholar 

  18. Ebata T, Hirano S, Konishi M et al (2018) Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer. Br J Surg 105:192–202

    Article  CAS  Google Scholar 

  19. Edeline J, Benabdelghani M, Bertaut A et al (2019) Gemcitabine and oxaliplatin chemotherapy or surveillance in resected biliary tract cancer (PRODIGE 12-ACCORD 18-UNICANCER GI): a randomized phase iii study. J Clin Oncol 37:658–667

    Article  CAS  Google Scholar 

  20. Primrose JN, Fox RP, Palmer DH et al (2019) Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol 20:663–673

    Article  CAS  Google Scholar 

  21. Furuse J, Okusaka T, Boku N et al (2008) S-1 monotherapy as first-line treatment in patients with advanced biliary tract cancer: a multicenter phase II study. Cancer Chemother Pharmacol 62:849–855

    Article  CAS  Google Scholar 

  22. Okusaka T, Ishii H, Funakoshi A et al (2006) Phase II study of single-agent gemcitabine in patients with advanced biliary tract cancer. Cancer Chemother Pharmacol 57:647–653

    Article  CAS  Google Scholar 

  23. Kobayashi S, Nagano H, Tomokuni A et al (2019) A prospective, randomized phase ii study of adjuvant gemcitabine versus S-1 after major hepatectomy for biliary tract cancer (KHBO 1208): kansai hepato-biliary oncology group. Ann Surg 270:230–237

    Article  Google Scholar 

  24. Itano O, Takemura Y, Kishida N et al (2020) A prospective feasibility study of one-year administration of adjuvant S-1 therapy for resected biliary tract cancer in a multi-institutional trial (Tokyo Study Group for Biliary Cancer: TOSBIC01). BMC Cancer 20:688. https://doi.org/10.1186/s12885-020-07185-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Yadav S, Xie H, Bin-Riaz I et al (2019) Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma: a propensity score matched analysis. Eur J Surg Oncol 45:1432–1438

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded by a Grants-in-Aid for Scientific Research (20K21633) from the Japan Society for the Promotion of Science, which is under the direction of the Ministry of Health, Labor, and Welfare, Japan.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan

    Hiroshi Kurahara, Yuko Mataki, Tetsuya Idichi, Yota Kawasaki, Shinichiro Mori, Ken Sasaki, Takaaki Arigami, Akihiro Nakajo & Takao Ohtsuka

  2. Department of Radiology, Kagoshima University, Kagoshima, Japan

    Yoshihiko Fukukura

  3. Department of Pathology, Kagoshima University, Kagoshima, Japan

    Michiyo Higashi

Authors
  1. Hiroshi Kurahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuko Mataki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsuya Idichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yota Kawasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinichiro Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ken Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takaaki Arigami
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Akihiro Nakajo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yoshihiko Fukukura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michiyo Higashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takao Ohtsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study’s conception and design. Acquisition of data was performed by YK, SM, KS, TA, and AN. Analysis and interpretation of data were performed by TI, YM, YF, and MH. The first draft of the manuscript was written by HK, and all authors commented on the previous version of the manuscript. Critical revision of the manuscript was performed by HK and TO. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hiroshi Kurahara.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and/or animals participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all the participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kurahara, H., Mataki, Y., Idichi, T. et al. Spread of lymph node metastasis and adjuvant therapy for distal cholangiocarcinoma. Int J Clin Oncol 27, 1212–1221 (2022). https://doi.org/10.1007/s10147-022-02175-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-022-02175-z

Keywords

Search

Navigation