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World Journal of Surgery

, Volume 42, Issue 9, pp 2919–2929 | Cite as

Defining Early Recurrence of Hilar Cholangiocarcinoma After Curative-intent Surgery: A Multi-institutional Study from the US Extrahepatic Biliary Malignancy Consortium

  • Xu-Feng Zhang
  • Eliza W. Beal
  • Jeffery Chakedis
  • Qinyu Chen
  • Yi Lv
  • Cecilia G. Ethun
  • Ahmed Salem
  • Sharon M. Weber
  • Thuy Tran
  • George Poultsides
  • Andre Y. Son
  • Ioannis Hatzaras
  • Linda Jin
  • Ryan C. Fields
  • Stefan Buettner
  • Charles Scoggins
  • Robert C. G. Martin
  • Chelsea A. Isom
  • Kamron Idrees
  • Harveshp D. Mogal
  • Perry Shen
  • Shishir K. Maithel
  • Carl R. Schmidt
  • Timothy M. Pawlik
Original Scientific Report

Abstract

Background

Time to tumor recurrence may be associated with outcomes following resection of hepatobiliary cancers. The objective of the current study was to investigate risk factors and prognosis among patients with early versus late recurrence of hilar cholangiocarcinoma (HCCA) after curative-intent resection.

Methods

A total of 225 patients who underwent curative-intent resection for HCCA were identified from 10 academic centers in the USA. Data on clinicopathologic characteristics, pre-, intra-, and postoperative details and overall survival (OS) were analyzed. The slope of the curves identified by linear regression was used to categorize recurrences as early versus late.

Results

With a median follow-up of 18.0 months, 99 (44.0%) patients experienced a tumor recurrence. According to the slope of the curves identified by linear regression, the functions of the two straight lines were y = −0.465x + 16.99 and y = −0.12x + 7.16. The intercept value of the two lines was 28.5 months, and therefore, 30 months (2.5 years) was defined as the cutoff to differentiate early from late recurrence. Among 99 patients who experienced recurrence, the majority (n = 80, 80.8%) occurred within the first 2.5 years (early recurrence), while 19.2% of recurrences occurred beyond 2.5 years (late recurrence). Early recurrence was more likely present as distant disease (75.1% vs. 31.6%, p = 0.001) and was associated with a worse OS (Median OS, early 21.5 vs. late 50.4 months, p < 0.001). On multivariable analysis, poor tumor differentiation (HR 10.3, p = 0.021), microvascular invasion (HR 3.3, p = 0.037), perineural invasion (HR 3.9, p = 0.029), lymph node metastases (HR 5.0, p = 0.004), and microscopic positive margin (HR 3.5, p = 0.046) were independent risk factors associated with early recurrence.

Conclusions

Early recurrence of HCCA after curative resection was common (~35.6%). Early recurrence was strongly associated with aggressive tumor characteristics, increased risk of distant metastatic recurrence and a worse long-term survival.

Notes

Acknowledgements

X.-F. Z. was supported in part by the China Scholarship Council and the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University (No. XJTU1AF-CRF-2017-004).

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Xu-Feng Zhang
    • 1
    • 2
  • Eliza W. Beal
    • 2
  • Jeffery Chakedis
    • 2
  • Qinyu Chen
    • 2
  • Yi Lv
    • 1
  • Cecilia G. Ethun
    • 3
  • Ahmed Salem
    • 4
  • Sharon M. Weber
    • 4
  • Thuy Tran
    • 5
  • George Poultsides
    • 5
  • Andre Y. Son
    • 6
  • Ioannis Hatzaras
    • 6
  • Linda Jin
    • 7
  • Ryan C. Fields
    • 7
  • Stefan Buettner
    • 8
  • Charles Scoggins
    • 9
  • Robert C. G. Martin
    • 9
  • Chelsea A. Isom
    • 10
  • Kamron Idrees
    • 10
  • Harveshp D. Mogal
    • 11
  • Perry Shen
    • 11
  • Shishir K. Maithel
    • 3
  • Carl R. Schmidt
    • 2
  • Timothy M. Pawlik
    • 2
    • 12
  1. 1.Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and EngineeringThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  2. 2.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer ResearchThe Ohio State University Wexner Medical CenterColumbusUSA
  3. 3.Division of Surgical Oncology, Department of Surgery, Winship Cancer InstituteEmory UniversityAtlantaUSA
  4. 4.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  5. 5.Department of SurgeryStanford University Medical CenterStanfordUSA
  6. 6.Department of SurgeryNew York UniversityNew YorkUSA
  7. 7.Department of SurgeryWashington University School of MedicineSt. LouisUSA
  8. 8.Division of Surgical Oncology, Department of SurgeryThe Johns Hopkins HospitalBaltimoreUSA
  9. 9.Division of Surgical Oncology, Department of SurgeryUniversity of LouisvilleLouisvilleUSA
  10. 10.Division of Surgical Oncology, Department of SurgeryVanderbilt University Medical CenterNashvilleUSA
  11. 11.Department of SurgeryWake Forest UniversityWinston-SalemUSA
  12. 12.Surgery, Oncology, Health Services Management and PolicyThe Ohio State University Wexner Medical CenterColumbusUSA

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