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Perineural Invasion in Extrahepatic Cholangiocarcinoma: Prognostic Impact and Treatment Strategies

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The significance of perineural invasion in extrahepatic cholangiocarcinoma has not been fully elucidated. This study aims to determine the prognostic impact of and optimal treatment strategy for perineural invasion in patients with extrahepatic cholangiocarcinoma.

Methods

Medical records of 133 patients with extrahepatic cholangiocarcinoma who underwent curative resection were reviewed retrospectively. Ninety-eight patients had perineural invasion and 35 patients did not. Univariate and multivariate survival analyses were performed to clarify the prognostic impact of and optimal treatment strategy for perineural invasion.

Results

Only tumor differentiation (P = 0.024) was independently associated with perineural invasion in the multivariate logistic regression model. Multivariate survival analysis revealed that perineural invasion (P = 0.002), resection margin status (P = 0.016), and International Union Against Cancer (UICC) pT factor (P = 0.015) were independent prognostic factors of overall survival. Overall 5-year survival rates for patients with and without perineural invasion were 28 and 74 %, respectively. Among 98 patients with perineural invasion, the use of adjuvant chemotherapy (P = 0.003), lymph node status (P = 0.015), resection margin status (P = 0.008), and UICC pT factor (P = 0.016) were independently associated with overall survival by multivariate analysis. Overall 5-year survival rates for patients with perineural invasion who did and did not receive adjuvant chemotherapy were 33 and 21 %, respectively (P = 0.023).

Conclusions

Perineural invasion is a potent prognostic factor in extrahepatic cholangiocarcinoma. Adjuvant chemotherapy may improve the overall survival of patients with perineural invasion.

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Authors and Affiliations

  1. Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yoshiaki Murakami, Kenichiro Uemura, Takeshi Sudo, Yasushi Hashimoto, Naru Kondo, Naoya Nakagawa, Takeshi Muto, Hayato Sasaki, Kazuhide Urabe & Taijiro Sueda

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  1. Yoshiaki Murakami
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  2. Kenichiro Uemura
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  3. Takeshi Sudo
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  4. Yasushi Hashimoto
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  5. Naru Kondo
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  6. Naoya Nakagawa
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  7. Takeshi Muto
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  8. Hayato Sasaki
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Correspondence to Yoshiaki Murakami.

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Murakami, Y., Uemura, K., Sudo, T. et al. Perineural Invasion in Extrahepatic Cholangiocarcinoma: Prognostic Impact and Treatment Strategies. J Gastrointest Surg 17, 1429–1439 (2013). https://doi.org/10.1007/s11605-013-2251-0

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  • DOI: https://doi.org/10.1007/s11605-013-2251-0

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