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Prediction of prognosis and resectability using MR imaging, clinical, and histopathological findings in patients with perihilar cholangiocarcinoma

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To predict poor overall survival (OS) and risk of residual tumor after surgery using MR imaging, clinical, and histopathological findings in perihilar cholangiocarcinoma.

Methods

196 patients with perihilar cholangiocarcinoma who underwent preoperative MRI and curative-intent surgery were retrospectively included. MRI findings were assessed by two radiologists. Clinical characteristics and histopathological results such as serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), T and N stage, and resection status, were also investigated. Cox regression analysis and the Kaplan–Meier method were used to identify prognostic factors for OS. We further analyzed the correlation between MRI features and residual tumors using logistic regression analysis.

Results

The median OS was 25.0 ± 26.6 months. T stage (hazard ratio [HR] 6.26, p = 0.014), N stage (HR 1.86, p = 0.002), CA-19-9 >37 U/mL (HR 2.06, p < 0.001), enlarged LN on MRI (HR 1.69, p = 0.006), and residual tumor (HR 1.52, p = 0.034) were important predictors of poor survival. The 5-year OS of the complete resection group (n = 107) was significantly better than that of the residual tumor group (n = 89) (35.5% vs. 18.8%, p = 0.002). Additionally, peritumoral fat stranding (odds ratio[OR] 2.09, p = 0.027), Bismuth type III/IV (OR 1.95, p = 0.022), and common bile duct (CBD) involvement (OR 2.3, p = 0.008) on MRI were important predictors of residual tumors in univariate analyses. However, absence of peritumoral fat stranding was a significant independent predictor for complete resection (OR 1.99, p = 0.048) and showed the highest sensitivity, at 79.8%.

Conclusion

MR imaging, clinical and histopathological results are useful for predicting poor survival after surgery for perihilar cholangiocarcinoma. Furthermore, MRI findings, including peritumoral fat stranding, CBD involvement, and Bismuth type, are important for the prediction of residual tumors.

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Data availability

We declared that materials described in the manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes, without breaching participant confidentiality.

Code availability

All softwares used during the study appear in the submitted article; No code was generated or used during the study.

Abbreviations

ALP:

Alkaline phosphatase

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CA 19-9:

Carbohydrate antigen 19-9

CBD:

Common bile duct

CEA:

Carcinoembryonic antigen

DWI:

Diffusion-weighted imaging

LN:

Lymph node

MDCT:

Multidetector computed tomography

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance imaging

OS:

Overall survival

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jeongin Yoo, Jung Hoon Kim, Jae Seok Bae & Hyo-Jin Kang

  2. Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jeongin Yoo, Jung Hoon Kim, Jae Seok Bae & Hyo-Jin Kang

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, Korea

    Jung Hoon Kim

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  1. Jeongin Yoo
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Contributions

Study conception and design: JHKim; Acquisition of data: JSB, H-JK; Data Analysis: JSB, H-JK; Data interpretation: JY, JHK; Drafting of manuscript: JY; Critical revision of manuscript: JHK.

Corresponding author

Correspondence to Jung Hoon Kim.

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Conflict of interest

All authors confirm that no disclosure of potential conflicts of interest.

Ethical approval

This study was approved by Institutional Review Board of Seoul National University Hospital (IRB No. 1807-043-957) and written informed consent was waived. This study was in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was waived by Institutional Review Board of Seoul National University Hospital due to retrospective design of the study.

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Yoo, J., Kim, J.H., Bae, J.S. et al. Prediction of prognosis and resectability using MR imaging, clinical, and histopathological findings in patients with perihilar cholangiocarcinoma. Abdom Radiol 46, 4159–4169 (2021). https://doi.org/10.1007/s00261-021-03101-z

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