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Prognostic Significance of Tumor Necrosis in Hilar Cholangiocarcinoma

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

Abstract

Background

Tumor necrosis and peritumoral fibrosis have both been suggested to have a prognostic value in selected solid tumors. However, little is known regarding their influence on tumor progression and prognosis in hilar cholangiocarcinoma (HC).

Methods

Surgically resected tumor specimens of HC (n = 47) were analyzed for formation of necrosis and extent of peritumoral fibrosis. Tumor necrosis and grade of fibrosis were assessed histologically and correlated with clinicopathological characteristics, tumor recurrence, and patients’ survival. Univariate Kaplan–Meier analysis and a stepwise multivariable Cox regression model were applied.

Results

Mild peritumoral fibrosis was evident in 12 tumor samples, moderate peritumoral fibrosis in 20, and high-grade fibrosis in 15. Necrosis was evident in 19 of 47 tumor samples. Patients with tumors characterized by necrosis showed a significantly decreased 5-year recurrence-free survival (37.9 vs. 25.7 %; p < .05) and a significantly decreased 5-year overall survival (42.6 vs. 12.4 %; p < .05), when compared with patients with tumors showing no necrosis. R status, tumor recurrence, and tumor necrosis were of prognostic value in the univariate analysis (all p < .05). Multivariate survival analysis confirmed tumor necrosis (p = .038) as the only independent prognostic variable.

Conclusions

The assessment of tumor necrosis appears as a valuable additional prognostic tool in routine histopathological evaluation of HC. These observations might have implications for monitoring and more individualized multimodal therapeutic strategies.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Author notes

    Authors and Affiliations

    1. Department of Surgery, Campus Virchow and Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany

      Georgi Atanasov MD, Felix Krenzien MD, Andreas Brandl MD, Julianna Paulina Englisch, Anja Reutzel-Selke PhD, Andreas Pascher MD, PhD, Johann Pratschke MD, PhD, Christian Benzing MD & Moritz Schmelzle MD, PhD

    2. Institute of Pathology, University Hospital Leipzig, Leipzig, Germany

      Katrin Schierle MD

    3. Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany

      Hans-Michael Hau MD, Corinna Dietel PhD & Georg Wiltberger MD

    4. The Transplant Institute and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA

      Simon C. Robson MD, PhD

    5. Department of Hepato-Pancreato-Biliary Surgery, 310Klinik Nürnberg, Nuremberg, Germany

      Sven Jonas MD, PhD

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    1. Georgi Atanasov MD
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    Corresponding author

    Correspondence to Georgi Atanasov MD.

    Additional information

    G. Atanasov, C. Benzing, and M. Schmelzle have contributed equally to this work.

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    Atanasov, G., Schierle, K., Hau, HM. et al. Prognostic Significance of Tumor Necrosis in Hilar Cholangiocarcinoma. Ann Surg Oncol 24, 518–525 (2017). https://doi.org/10.1245/s10434-016-5472-0

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    • DOI: https://doi.org/10.1245/s10434-016-5472-0

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