Nationwide treatment and outcomes of perihilar cholangiocarcinoma

Keulen, Anne-Marleen van; Franssen, Stijn; Geest, Lydia G. van der; Boer, Marieke T. de; Coenraad, Minneke J.; Driel, Lydi M.J.W. van; Erdmann, Joris I.; Mohammad, Nadia Haj; Heij, Lara; Klümpen, Heinz‐Josef; Tjwa, Eric T.; Iersel, Liselot Valkenburg-van; Verheij, Joanne; Koerkamp, Bas Groot; Olthof, Pim B.

doi:10.1111/liv.14856

Cited by 34 publications

(21 citation statements)

References 42 publications

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“…The survival of patients with unresectable pCCA is poor, however it varies between studies, with survival ranging from 3 to 10 months [41][42][43]. Therefore, the calculated pooled median survival rates in this systematic review cannot be compared with current literature on overall survival.…”

Section: Discussionmentioning

confidence: 97%

Comparison of Intraductal RFA Plus Stent versus Stent-Only Treatment for Unresectable Perihilar Cholangiocarcinoma—A Systematic Review and Meta-Analysis

Jong

Fritzsche

Audhoe

et al. 2022

Cancers

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Background: One of the cornerstones of palliative treatment for unresectable perihilar cholangiocarcinoma is biliary stent placement in order to restore biliary drainage. In this review, the potential added value of RFA with stent placement in comparison to stent placement alone in patients with unresectable perihilar cholangiocarcinoma is analyzed. Methods: We performed a comprehensive online search for relevant articles in November 2021 (PROSPERO ID: CRD42021288180). The primary endpoint was difference in overall survival. Secondary endpoints included overall survival, stent patency and complications. Only studies comparing survival after RFA + stent placement with stent placement alone were included in the meta-analysis. Non-comparative studies or comparative studies describing stent patency only were included in the systematic review. Results: A total of nine studies, including 217 patients with pCCA who underwent RFA + stent placement and 294 patients who underwent stent-only treatment, met the inclusion criteria for the primary endpoint analysis. Direct comparison between the two treatment groups showed a significantly longer overall survival for RFA + stent treatment, with a pooled HR of 0.65 [95% CI, 0.50–0.84, I2 = 38%]. When all eligible studies were included, RFA + stent treatment revealed an overall survival of 9.5 months [95% CI, 6.3–12.6], whereas survival for stent-only treatment was 7.0 months [95% CI, 5.7–8.2]. Due to the heterogeneity of the data, no pooled data analysis could be performed on stent patency or complications. Conclusions: RFA + stent placement displays promising potential to prolong survival. However, further research incorporating confounding factors like use of palliative chemotherapy is necessary in order to validate these findings.

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Section: Discussionmentioning

confidence: 97%

Comparison of Intraductal RFA Plus Stent versus Stent-Only Treatment for Unresectable Perihilar Cholangiocarcinoma—A Systematic Review and Meta-Analysis

Jong

Fritzsche

Audhoe

et al. 2022

Cancers

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“…Cholangiocarcinoma is a rare tumour that accounts for less than 1% of all human cancers 1 . Often, at the time of diagnosis, the disease is at an unresectable stage, and therefore not curable in 85% of cases 2 . Palliative and supportive treatment for these patients typically involves minimally invasive management.…”

Section: Discussionmentioning

confidence: 99%

“…Patients often present with symptoms such as jaundice, pruritus and recurrent cholangitis, which can significantly impact their quality of life and liver function. Such symptoms may even cause interruptions in palliative chemotherapy in patients who may otherwise benefit from it. 2 …”

Section: Discussionmentioning

confidence: 99%

Segment 3 cholangiojejunostomy for unresectable peri‐hilar cholangiocarcinoma: A case report and literature review

et al. 2023

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Surgical management of unresectable perihilar cholangiocarcinoma is no longer relevant. Often these patients benefit from less invasive endoscopic or radiological management, but in the event of failure of these techniques, and in selected patients, cholangiojejunostomy in segment 3 can be an effective option. We describe the case of a 48‐year‐old patient presenting with an unresectable perihilar cholangiocarcinoma, in whom palliative endoscopic management failed two times and an open segment 3 intrahepatic cholangiojejunostomy was performed. The patient was discharged on the 7th day, has a complete resolution of jaundice at 2 months and is alive at 6 months without any readmission.

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“…According to the anatomical location, CCA is divided into three subtypes, and perihilar cholangiocarcinoma (pCCA) represents the most common type of CCA ( 3 ). PCCA carries a poor prognosis with a median overall survival (OS) of 5-10 months ( 4 ). Surgery resection with an R0 margin can significantly prolong OS and provide a chance to cure pCCA.…”

Section: Introductionmentioning

confidence: 99%

“…Surgery resection with an R0 margin can significantly prolong OS and provide a chance to cure pCCA. However, only 13% to 32% of pCCA patients undergo surgical resection and the recurrence rate within one year was greater than 50% ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

CT-Based Radiomics Analysis for Noninvasive Prediction of Perineural Invasion of Perihilar Cholangiocarcinoma

Zhan

Lyu

et al. 2022

Front. Oncol.

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PurposeThe study aimed to construct and evaluate a CT-Based radiomics model for noninvasive detecting perineural invasion (PNI) of perihilar cholangiocarcinoma (pCCA) preoperatively.Materials and MethodsFrom February 2012 to October 2021, a total of 161 patients with pCCA who underwent resection were retrospectively enrolled in this study. Patients were allocated into the training cohort and the validation cohort according to the diagnostic time. Venous phase images of contrast-enhanced CT were used for radiomics analysis. The intraclass correlation efficient (ICC), the correlation analysis, and the least absolute shrinkage and selection operator (LASSO) regression were applied to select radiomics features and built radiomics signature. Logistic regression analyses were performed to establish a clinical model, a radiomics model, and a combined model. The performance of the predictive models was measured by area under the receiver operating characteristic curve (AUC), and pairwise ROC comparisons between models were tested using the Delong method. Finally, the model with the best performance was presented as a nomogram, and its calibration and clinical usefulness were assessed.ResultsFinally, 15 radiomics features were selected to build a radiomics signature, and three models were developed through logistic regression. In the training cohort, the combined model showed a higher predictive capability (AUC = 0.950) than the radiomics model and the clinical model (AUC: radiomics = 0.914, clinical = 0.756). However, in the validation cohort, the AUC of the radiomics model (AUC = 0.885) was significantly higher than the other two models (AUC: combined = 0.791, clinical = 0.567). After comprehensive consideration, the radiomics model was chosen to develop the nomogram. The calibration curve and decision curve analysis (DCA) suggested that the nomogram had a good consistency and clinical utility.ConclusionWe developed a CT-based radiomics model with good performance to noninvasively predict PNI of pCCA preoperatively.

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Nationwide treatment and outcomes of perihilar cholangiocarcinoma

Cited by 34 publications

References 42 publications

Comparison of Intraductal RFA Plus Stent versus Stent-Only Treatment for Unresectable Perihilar Cholangiocarcinoma—A Systematic Review and Meta-Analysis

Comparison of Intraductal RFA Plus Stent versus Stent-Only Treatment for Unresectable Perihilar Cholangiocarcinoma—A Systematic Review and Meta-Analysis

Segment 3 cholangiojejunostomy for unresectable peri‐hilar cholangiocarcinoma: A case report and literature review

CT-Based Radiomics Analysis for Noninvasive Prediction of Perineural Invasion of Perihilar Cholangiocarcinoma

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