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

Sahara, Kota; Tsilimigras, Diamantis I.; Toyoda, Junya; Miyake, Kentaro; Ethun, Cecilia G.; Maithel, Shishir K.; Abbott, Daniel E.; Poultsides, George A.; Hatzaras, Ioannis; Fields, Ryan C.; Weiss, Matthew J.; Scoggins, Charles R.; Isom, Chelsea A.; Idrees, Kamran; Shen, Perry; Yabushita, Yasuhiro; Matsuyama, Ryusei; Endo, Itaru; Pawlik, Timothy M.

doi:10.1245/s10434-021-09811-4

Cited by 24 publications

(21 citation statements)

References 41 publications

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“…The ER definition from the four studies ranged from 12 to 24 months, consistent with the studies of other hepatobiliary cancers such as hepatocellular carcinoma or distal cholangiocarcinoma. [8][9][10]29,36,37 However, the measured prognostic factors differed across the included studies, with varying adjusted and unadjusted analyses. The rare nature of the disease, the relatively novel concept of ER, and the majority of published studies from single-center populations may have been the reasons for such observed heterogenicity.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Prognostic Factors for Early Recurrence in Intrahepatic Cholangiocarcinoma After Curative-Intent Resection

et al. 2022

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Background. Recurrence rates of intrahepatic cholangiocarcinoma (iCCA) after curative hepatectomy are as high as 50% to 70%, and about half of these recurrences occur within 2 years. This systematic review aims to define prognostic factors (PFs) for early recurrence (ER, within 24 months) and 24-month disease-free survival (DFS) after curative-intent iCCA resections. Methods. Systematic searching was performed from database inception to 14 January 2021. Duplicate independent review and data extraction were performed. Data on 13 predefined PFs were collected. Meta-analysis was performed on PFs for ER and summarized using forest plots. The Quality in Prognostic Factor Studies tool was used for risk-of-bias assessment.Results. The study enrolled 10 studies comprising 4158 patients during an accrual period ranging from 1990 to 2016. In the risk-of-bias assessment of patients who experienced ER after curative-intent iCCA resection, six studies were rated as low risk and four as moderate risk (49.6%; 95% confidence interval [CI], 49.2-50.0). Nine studies were pooled for meta-analysis. Of the postoperative PFs, multiple tumors, microvascular invasion, macrovascular invasion, lymph node metastasis, and R1 resection were associated with an increased hazard for ER or a reduced 24-month DFS, and the opposite was observed for receipt of adjuvant chemo/radiation therapy. Of the preoperative factors, cirrhosis, sex, HBV status were not associated with ER or 24-month DFS. Conclusion. The findings from this systematic review could allow for improved surveillance, prognostication, and treatment decision-making for patients with resectable iCCAs. Further well-designed prospective studies are needed to explore prognostic factors for iCCA ER with a focus on preoperative variables.Intrahepatic cholangiocarcinoma (iCCA) is the second most common type of primary liver cancer, with an incidence of 0.85 per 100,000 annually. 1,2 Although iCCA is a rare and complex disease, its incidence in in North America has increased almost five-fold, and the reasons for this increase are not clear. 3,4 Surgery remains the mainstay therapy for curative intent, but only about 20% of iCCAs are surgically resectable at the time of diagnosis. In addition, the recurrence rates after liver resection (LR) are exceedingly high, reaching 50-70% and leaving limited treatment options. [5][6][7] In fact, most of the recurrence occurs relatively early, about 25% within 6 months and 50% within 2 years after surgery. 8

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Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Prognostic Factors for Early Recurrence in Intrahepatic Cholangiocarcinoma After Curative-Intent Resection

et al. 2022

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“…Routine postoperative CA19-9 level recommendations have not yet been established, but studies have demonstrated that an elevated perioperative CA19-9 level is associated with decreased OS [ 82 ]. After curative-intent Whipple procedure for dCCA, the most common sites of locoregional recurrence are the superior mesenteric artery nodes, abdominal aortic nodes, celiac artery nodes, and nodes along the hepatoduodenal ligament [ 83 , 84 , 85 ]. The most frequent metastatic site includes the liver followed by metastasis to the peritoneum, lymph nodes, and lungs [ 17 , 86 ].…”

Section: Recurrencementioning

confidence: 99%

Surgical Treatment of Distal Cholangiocarcinoma

Gorji¹,

Beal

2022

Current Oncology

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Distal cholangiocarcinoma (dCCA) is a rare malignancy arising from the epithelial cells of the distal biliary tract and has a poor prognosis. dCCA is often clinically silent and patients commonly present with locally advanced and/or distant disease. For patients identified with early stage, resectable disease, surgical resection with negative margins remains the only curative treatment strategy available. However, despite appropriate treatment and diligent surveillance, risk of recurrence remains high with nearly 50% of patients experiencing recurrence at 5 years subsequent to surgical resection; therefore, it is prudent to continue to optimize neoadjuvant and adjuvant therapies in order to reduce the risk of recurrence and improve overall survival. In this review, we discuss the clinical presentation, workup and surgical treatment of dCCA.

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“…High NLR, platelet-to-lymphocyte ratio (PLR), and FAR values and low lymphocyte-tomonocyte ratio (LMR) values could be prognostic factors for short overall survival (OS) in patients with CCA (10)(11)(12). There have been some studies on ICC (13)(14)(15)(16)); however, very few studies have referred to ECC, PCC (11), and DCC (17,18).…”

Section: Introductionmentioning

confidence: 99%

Preoperative peripheral blood inflammatory markers especially the fibrinogen-to-lymphocyte ratio and novel FLR-N score predict the prognosis of patients with early-stage resectable extrahepatic cholangiocarcinoma

Zhang

Lou

et al. 2022

Front. Oncol.

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BackgroundSystemic inflammation is important in the development of extrahepatic cholangiocarcinoma (ECC). The aim of this study was to compare the prognostic power of preoperative peripheral blood inflammatory markers and the novel FLR-N score in patients with resectable ECC.MethodsA total of 140 patients with resectable ECC and 140 healthy controls (HCs) were recruited for the study. The Mann−Whitney U test was used to evaluate the differences in inflammatory markers between groups. Kaplan−Meier and Cox regression analyses were used to evaluate the prognostic power of preoperative fibrinogen, albumin, prealbumin, bilirubin, neutrophils, lymphocytes, monocytes, platelets, fibrinogen-to-lymphocyte ratio (FLR), fibrinogen-to-albumin ratio (FAR), fibrinogen-to-prealbumin ratio (FPR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), FLR-neutrophil (FLR-N) score, and CA19-9 in patients with resectable ECC. Nomogram was developed based on the results of multivariate Cox analyses.ResultsPatients with resectable ECC had significantly higher levels of neutrophils, monocytes, fibrinogen, FLR, FAR, FPR, NLR, PLR, and MLR and lower levels of lymphocytes, albumin, and prealbumin than HCs (all P < 0.01). Albumin, prealbumin, and FPR had a good ability to distinguish between ECC patients with total bilirubin < 34 µmol/L and HCs (AUCs of 0.820, 0.827, and 0.836, respectively). Kaplan−Meier analysis showed that high neutrophil, fibrinogen, FLR, FAR, PLR, MLR, and FLR-N score values were associated with poor survival in patients with resectable ECC. Multivariate analyses indicated that neutrophils (P = 0.022), FLR (P = 0.040), FLR-N score (P < 0.0001), and positive lymph node metastasis (P = 0.016) were independent factors for overall survival (OS). Nomogram were developed to predict OS for patients with ECC.ConclusionThe prognostic roles of inflammatory markers in patients with resectable ECC were different. The preoperative neutrophil count, FLR and FLR-N score could serve as noninvasive markers for predicting the prognosis of resectable ECC.

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

Cited by 24 publications

References 41 publications

Systematic Review and Meta-Analysis of Prognostic Factors for Early Recurrence in Intrahepatic Cholangiocarcinoma After Curative-Intent Resection

Systematic Review and Meta-Analysis of Prognostic Factors for Early Recurrence in Intrahepatic Cholangiocarcinoma After Curative-Intent Resection

Surgical Treatment of Distal Cholangiocarcinoma

Preoperative peripheral blood inflammatory markers especially the fibrinogen-to-lymphocyte ratio and novel FLR-N score predict the prognosis of patients with early-stage resectable extrahepatic cholangiocarcinoma

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