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Defining the Risk of Early Recurrence Following Curative-Intent Resection for Distal Cholangiocarcinoma

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

Abstract

Background

Although multidisciplinary treatments including the use of adjuvant therapy (AT) have been adopted for biliary tract cancers, patients with distal cholangiocarcinoma (DCC) can still experience recurrence. We sought to characterize the incidence and predictors of early recurrence (ER) that occurred within 12 months following surgery for DCC.

Patients and Methods

Patients who underwent resection for DCC between 2000 and 2015 were identified from the US multi-institutional database. Cox regression analysis was used to identify clinicopathological factors to develop an ER risk score, and the predictive model was validated in an external dataset.

Results

Among 245 patients included in the analysis, 67 patients (27.3%) developed ER. No difference was noted in ER rates between patients who did and did not receive AT (28.7% vs. 25.0%, p = 0.55). Multivariable analysis revealed that neutrophil-to-lymphocyte ratio (NLR), peak total bilirubin (T-Bil), major vascular resection (MVR), lymphovascular invasion, and R1 surgical margin status were associated with a higher ER risk. A DIstal Cholangiocarcinoma Early Recurrence Score was developed according to each factor available prior to surgery [NLR > 9.0 (2 points); peak T-bil > 1.5 mg/dL (1 points); MVR (2 points)]. Cumulative ER rates incrementally increased among patients who were low (0 points; 10.6%), intermediate (1–2 points; 26.8%), or high (3–5 points; 57.6%) risk (p < 0.001) in the training dataset, as well as in the validation dataset [low (0 points); 3.4%, intermediate (1–2 points); 32.7%, or high risk (3–5 points); 55.6% (p < 0.001)].

Conclusions

Among patients undergoing resection for DCC, 1 in 4 patients experienced an ER. Alternative treatment strategies such as neoadjuvant chemotherapy may be considered especially among individuals deemed to be at high risk for ER.

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Funding

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Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan

    Kota Sahara MD, Junya Toyoda MD, Kentaro Miyake MD, PhD, Yasuhiro Yabushita MD, PhD, Ryusei Matsuyama MD, PhD & Itaru Endo MD, PhD

  2. Division of Surgical Oncology, Health Services Management and Policy, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Kota Sahara MD, Diamantis I. Tsilimigras MD & Timothy M. Pawlik MD, MPH, MTS, PhD, FACS

  3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Cecilia G. Ethun MD & Shishir K. Maithel MD

  4. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Daniel E. Abbott MD

  5. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George A. Poultsides MD

  6. Department of Surgery, New York University, New York, NY, USA

    Ioannis Hatzaras MD

  7. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA

    Ryan C. Fields MD

  8. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

  9. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA

    Charles Scoggins MD

  10. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Chelsea A. Isom MD & Kamran Idrees MD

  11. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Perry Shen MD

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  1. Kota Sahara MD
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  2. Diamantis I. Tsilimigras MD
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  19. Timothy M. Pawlik MD, MPH, MTS, PhD, FACS
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Correspondence to Timothy M. Pawlik MD, MPH, MTS, PhD, FACS.

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Supplementary Information

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Supplementary file1 (DOCX 14 KB)

10434_2021_9811_MOESM2_ESM.tiff

Supplementary Fig. 1 KM curves demonstrating differences in OS after recurrence among patients with ER versus LR (TIFF 145 KB)

10434_2021_9811_MOESM3_ESM.tiff

Supplementary Fig. 2 KM curves demonstrating differences in RFS stratified by the DICER score only among patients (a) with and (b) without AT (TIFF 156 KB)

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Sahara, K., Tsilimigras, D.I., Toyoda, J. et al. Defining the Risk of Early Recurrence Following Curative-Intent Resection for Distal Cholangiocarcinoma. Ann Surg Oncol 28, 4205–4213 (2021). https://doi.org/10.1245/s10434-021-09811-4

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