Recurrence after curative-intent resection of perihilar cholangiocarcinoma: analysis of a large cohort with a close postoperative follow-up approach

Komaya, Kenichi; Ebata, Tomoki; Yokoyama, Yukihiro; Igami, Tsuyoshi; Sugawara, Gen; Mizuno, Takashi; Yamaguchi, Junpei; Nagino, Masato

doi:10.1016/j.surg.2017.08.011

Cited by 103 publications

(81 citation statements)

References 33 publications

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“…Interestingly, the cut‐off points of 1, 5 and 8 mm reported in the present study are similar to those in other studies of distal or extrahepatic cholangiocarcinoma. A C1 tumour (ITT less than 1 mm) was highly associated with intraductal growth type, well differentiated histological grade, rare microscopic neurovascular invasion and absence of nodal metastasis ( Table ); all of these factors are well known positive prognostic indicators. Thus, an ITT below 1 mm represents early‐stage disease.…”

Section: Discussionsupporting

confidence: 88%

Proposal for a new classification for perihilar cholangiocarcinoma based on tumour depth

Shinohara

Shimoyama

Nakaguro

et al. 2019

British Journal of Surgery

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Background: The T system for distal cholangiocarcinoma has been revised from a layer-based to a depth-based approach in the current American Joint Committee on Cancer (AJCC) classification. In perihilar cholangiocarcinoma, tumour depth in the staging scheme has not yet been addressed. The aim of this study was to propose a new T system using measured tumour depth in perihilar cholangiocarcinoma.Methods: Patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2001 and 2014 were reviewed retrospectively. The vertical distance between the top of the tumour and deepest invasive cells was measured as invasive tumour thickness (ITT) by two independent pathologists. Log rank statistics were used to determine cut-off points, and the concordance (C) index was used to assess survival discrimination of each T system. Results: ITT was measurable in all 440 patients, with a median value of 6⋅0 (range 0-45) mm. The median difference in ITT between observers was 0⋅6 (range 0-20) mm. Cut-off points for prognosis were 1, 5 and 8 mm. Five-year survival decreased with increasing ITT (P < 0⋅001): 67 per cent for ITT less than 1 mm (25 patients), 54⋅9 per cent for ITT 1 mm and over to less than 5 mm (138 patients), 43⋅4 per cent for ITT 5 mm and over to less than 8 mm (118 patients), and 32⋅2 per cent for ITT 8 mm and over (159 patients). The C-index of this classification was comparable to that of the current AJCC T classification (0⋅598 versus 0⋅589).Conclusion: ITT is a reliable approach for making a depth assessment in perihilar cholangiocarcinoma. A four-tier ITT classification with cut-off points of 1, 5 and 8 mm is an adequate alternative to the current layer-based T classification.

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Section: Discussionsupporting

confidence: 88%

Proposal for a new classification for perihilar cholangiocarcinoma based on tumour depth

Shinohara

Shimoyama

Nakaguro

et al. 2019

British Journal of Surgery

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“…Among 36 patients with neoadjuvant therapy, the rates of G3, T4, N1-2, and M1 in high TB group were significantly higher than those in low TB. As for postoperative factors, there were no differences between two groups in both patients with and without neoadjuvant therapy Many studies have reported several prognostic factors, such as presence of higher histological grade (G3), higher T stage, lymph node metastasis, and positive surgical resection margin, associated with poor survival in resected patients with cholangiocarcinoma [3,[22][23][24]. In the previous study on TB in extrahepatic cholangiocarcinoma, Ogino, et al [11] demonstrated high TB as an independent adverse prognostic factor in multivariate analysis, along with higher T stage, lymph node metastasis, and resected margin positive invasive carcinoma.…”

Section: Discussionmentioning

confidence: 99%

High tumor budding is a strong predictor of poor prognosis in the resected perihilar cholangiocarcinoma patients regardless of neoadjuvant therapy, showing survival similar to those without resection

et al. 2020

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Background: Tumor budding (TB) is used as an indicator of poor prognosis in various cancers. However, studies on TB in perihilar cholangiocarcinoma are still limited. We examined the significance of TB in resected perihilar cholangiocarcinoma with or without neoadjuvant therapy. Methods: Seventy-eight patients who underwent surgical resection at our institution for perihilar cholangiocarcinoma from 2004 to 2017, (36 with neoadjuvant therapy), were enrolled in this study. TB was defined as an isolated cancer cell or clusters (< 5 cells) at the invasive front and the number of TB was counted using a 20 times objective lens. Patients were classified into two groups according to TB counts: low TB (TB < 5) and high TB (TB ≥5). Results: In this 78 patient cohort, high TB was significantly associated with advanced tumor status (pT4: 50.0% vs 22.2%, p = 0.007, pN1/2: 70.8% vs 39.6%, p = 0.011, M1: 20.8% vs 1.9%) and higher histological grade (G3: 25.0% vs 5.7%, p = 0.014). Disease specific survival (DSS) in high TB was significantly inferior compared to that in low TB group (3-y DSS 14.5% vs 67.7%, p < 0.001). Interestingly, DSS in high TB showed similar to survival in unresected patients. In addition, high TB was also associated with advanced tumor status and poor prognosis in patients with neoadjuvant therapy. Multivariate analysis identified high TB as an independent poor prognostic factors for DSS (HR: 5.206, p = 0.001). Conclusion: This study demonstrated that high TB was strongly associated with advanced tumor status and poor prognosis in resected perihilar cholangiocarcinoma patients. High TB can be a novel poor prognostic factor in resected perihilar cholangiocarcinoma regardless of neoadjuvant therapy.

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“…1,3 If surgical tumor resection is not feasible, chemotherapy with gemcitabine and cisplatin represents the standard of care, resulting in a median overall survival (OS) of 10-12 months. [4][5][6] Importantly, the postoperative outcome following BTC resection is very heterogeneous and the majority of successfully resected patients (R 0 resection) face disease recurrence, 7 resulting in an overall 5-year survival rate of less than 30%. [8][9][10] Moreover, while current data suggest a benefit of more aggressive adjuvant treatment regimens in pancreatic cancer, which shares many clinicopathological similarities with BTC, 11 data from lager clinical trials evaluating this concept in patients with BTC are still missing (NCT02170090).…”

Section: Introductionmentioning

confidence: 99%

Circulating levels of soluble urokinase plasminogen activator receptor predict outcome after resection of biliary tract cancer

et al. 2020

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suPAR pre-OP Log-rank = 8.003 p = 0.005 2,500 Overall survival Circulating suPAR Biliary Tract Cancer (BTC) Highlights Biliary tract cancer is associated with poor outcomes and increasing incidence. Surgical resection is the only potentially curative treatment option for patients with biliary tract cancer. The identification of ideal surgical candidates has remained challenging. Circulating suPAR represents a novel diagnostic and prognostic biomarker in resectable patients. SuPAR might be useful to identify patients with biliary tract cancer who will benefit most from tumor resection.

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Recurrence after curative-intent resection of perihilar cholangiocarcinoma: analysis of a large cohort with a close postoperative follow-up approach

Cited by 103 publications

References 33 publications

Proposal for a new classification for perihilar cholangiocarcinoma based on tumour depth

Proposal for a new classification for perihilar cholangiocarcinoma based on tumour depth

High tumor budding is a strong predictor of poor prognosis in the resected perihilar cholangiocarcinoma patients regardless of neoadjuvant therapy, showing survival similar to those without resection

Circulating levels of soluble urokinase plasminogen activator receptor predict outcome after resection of biliary tract cancer

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