Relevant prognostic factors influencing outcome of patients after surgical resection of distal cholangiocarcinoma

Beetz, Oliver; Klein, Michael; Schrem, Harald; Gwiasda, Jill; Vondran, Florian W. R.; Oldhafer, Felix; Cammann, Sebastian; Klempnauer, Jürgen; Oldhafer, Karl J.; Kleine, Moritz

doi:10.1186/s12893-018-0384-5

Cited by 22 publications

(23 citation statements)

References 40 publications

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“…Surgical resection by pancreaticoduodenectomy remains the only definitively curative therapy for the long-term survival of distal cholangiocarcinoma patients [ 4 ]. And the 5-year survival rate of distal cholangiocarcinoma after pancreatoduodenectomy ranged from 22 to 47% [ 5 – 7 ]. Lymph node metastasis is widely accepted as an important survival factor for distal cholangiocarcinoma patients [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of lymph node parameters in distal cholangiocarcinoma after pancreaticoduodenectomy

Lyu

Zhao

et al. 2020

World J Surg Onc

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Background Pancreaticoduodenectomy is the only definitively curative therapy for the long-term survival of distal cholangiocarcinoma patients. Lymph node metastasis is widely accepted as an important prognostic factor for distal cholangiocarcinoma. The latest American Joint Committee on Cancer (AJCC) TNM classification system for distal cholangiocarcinoma has divided the lymph node metastasis patients into N1 and N2 by lymph node metastasis number. However, some studies suggested that the lymph node metastasis ratio may be better than the lymph node metastasis number. Therefore, we develop a program to analyze the correlation between lymph node parameters (lymph node dissection number, lymph node metastasis number, and lymph node metastasis rate) and long-term prognosis. Methods We retrospectively reviewed 123 distal cholangiocarcinoma patients after pancreatoduodenectomy from January 2011 to December 2019. The patients were grouped according to lymph node metastases and tumor-free and overall survival rates which were investigated with the Kaplan-Meier analysis. The logistic regression models were used for multivariate analysis to determine the risk factors for lymph node metastases. And the X-tile program was used to calculate the cutoff values for the lymph node parameters that discriminated survival. Results The 1-year, 3-year, and 5-year overall survival rates of patients with distal cholangiocarcinoma after pancreatoduodenectomy were 75.2%, 37.1%, and 31.5%, respectively. And the 1-year, 3-year, and 5-year overall survival rates of patients without and with lymph node metastasis were 83.0%, 50.7%, and 42.5% and 63.5%, 19.0%, and 19.0% (p = 0.000), respectively. Logistic regression showed CA19-9 and portal vein system invasion as independent risk factors for lymph node metastases. The receiver operating characteristic curve showed the optimal cutoff value of CA19-9 to predict the lymph node metastases was 75.5 U/mL. Determined by the X-tile software, the optimal cutoff values of the lymph node dissection number were 24 (p = 0.021), the lymph node metastasis number were 1 and 7 (p = 0.504), and the lymph node metastasis rate were 0.13 (p = 0.002). Conclusion Lymph node metastasis is an important factor affecting the long-term survival of distal cholangiocarcinoma patients.CA19-9 and portal vein system invasion are independent risk factors for lymph node metastasis. Besides, the lymph node dissection number and lymph node metastasis rate can predict the long-term survival better than lymph node metastasis number.

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Section: Introductionmentioning

confidence: 99%

Prognostic impact of lymph node parameters in distal cholangiocarcinoma after pancreaticoduodenectomy

Lyu

Zhao

et al. 2020

World J Surg Onc

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“…Cholangiocarcinoma (CCA) is a primary liver cancer with features of differentiation of cholangiocytes, the epithelial cells lining the intra- and extrahepatic portions of the biliary tree [ 1 ]. An increasing incidence of CCA has been reported over the last few decades [ 2 ]. It is the second most frequent type of primary liver cancer and comprises malignancies with high inter- and intratumor heterogeneities.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Platelet-to-Lymphocyte Ratio in Cholangiocarcinoma: A Meta-Analysis

et al. 2018

BioMed Research International

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Introduction Pretreatment platelet-to-lymphocyte ratio (PLR) has been considered a prognostic factor in various cancers. However, the application of PLR in the assessment of patients with cholangiocarcinoma remains controversial. This study aimed to evaluate the prognostic value of pretreatment PLR in cholangiocarcinoma. Methods A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library to identify studies assessing the prognostic significance of the pretreatment PLR in cholangiocarcinoma. Three databases were searched from inception to August 5, 2018. The primary outcome was overall survival (OS), and the secondary outcomes were recurrence-free survival (RFS) and progression-free survival (PFS). Pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Results A total of 9 studies including 2395 patients were finally enrolled in the meta-analysis based on the inclusion and exclusion criteria. All of the included studies were retrospective observational cohorts. Elevated PLR predicted poor OS (HR: 1.38, 95% CI: 1.19-1.62, P < 0.001) and RFS or PFS (HR = 1.55; 95% CI = 1.27-1.88; P < 0.001). Moreover, elevated PLR was highly associated with male sex (male versus female OR = 0.59, 95% CI: 0.44-0.80, P < 0.001) and R1 resection margin (OR = 2.09, 95% CI: 1.24-3.54, P = 0.006). Conclusion The present meta-analysis demonstrated that pretreatment PLR might serve as a useful prognostic biomarker in cholangiocarcinoma.

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“…Preoperative biliary drainage is recommended in patients with cholangitis, intense symptomatic jaundice, jaundice before neoadjuvant chemotherapy, delayed surgery, severe malnutrition, and liver or kidney failure, as well as in candidates for portal vein embolization[6,46]. Despite the fact that preoperative biliary drainage has been seen to reduce morbidity and mortality overall[3], there is some controversy over its indication in patients with severe jaundice: some studies have shown a greater risk of postoperative complications[47] and lower survival, possibly as a result of delaying surgery[48]. Nevertheless, a more recent retrospective study recommends preoperative biliary drainage in order to increase survival[49].…”

Section: Endoscopic and Radiological Managementmentioning

confidence: 99%

Diagnostic-therapeutic management of bile duct cancer

Huguet¹,

Lobo²,

Labrador³

et al. 2019

WJCC

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Biliary tract cancer, or cholangiocarcinoma, comprises a heterogeneous group of malignant tumors that can emerge at any part of the biliary tree. This group is the second most common type of primary liver cancer. Diagnosis is usually based on symptoms, which may be heterogeneous, and nonspecific biomarkers in serum and biopsy specimens, as well as on imaging techniques. Endoscopy-based diagnosis is essential, since it enables biopsy specimens to be taken. In addition, it can help with locoregional staging of distal tumors. Endoscopic retrograde cholangiopancreatography is a key technique for the evaluation and treatment of malignant biliary tumors. Correct staging of cholangiocarcinoma is essential in order to be able to determine the degree of resectability and assess the results of treatment. The tumor is staged based on the TNM classification of the American Joint Committee on Cancer. The approach will depend on the classification of the tumor. Thus, some patients with early-stage disease could benefit from surgery; complete surgical resection is the cornerstone of cure. However, only a minority of patients are diagnosed in the early stages and are suitable candidates for resection. In the subset of patients diagnosed with locally advanced or metastatic disease, chemotherapy has been used to improve outcome and to delay tumor progression. The approach to biliary tract tumors should be multidisciplinary, involving experienced endoscopists, oncologists, radiologists, and surgeons.

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Relevant prognostic factors influencing outcome of patients after surgical resection of distal cholangiocarcinoma

Cited by 22 publications

References 40 publications

Prognostic impact of lymph node parameters in distal cholangiocarcinoma after pancreaticoduodenectomy

Prognostic impact of lymph node parameters in distal cholangiocarcinoma after pancreaticoduodenectomy

Prognostic Significance of Platelet-to-Lymphocyte Ratio in Cholangiocarcinoma: A Meta-Analysis

Diagnostic-therapeutic management of bile duct cancer

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