Survival analysis and prognostic nomogram for patients undergoing resection of extrahepatic cholangiocarcinoma

Gaag, Niels A. van der; Kloek, Jaap J.; Bakker, Jeanette; Musters, Boudewijn; Geskus, Ronald B.; Busch, Olivier R.; Bosma, A.; Gouma, Dirk J.; Gulik, Thomas M. van

doi:10.1093/annonc/mds077

Cited by 89 publications

(64 citation statements)

References 31 publications

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“…Distal cholangiocarcinoma still remains a disease with a poor prognosis due to local recurrence and distant metastatic spread. Tumor differentiation and nodal status have been confirmed as important prognostic factors in univariate analysis as already investigated in previous studies [14,19,24,30,31]. Metastatic spread to locoregional lymph nodes is a major negative prognostic factor, but the correct staging requires harvesting a number of lymph nodes that cannot be obtained with a simple bile duct resection alone.…”

Section: Discussionmentioning

confidence: 65%

Pancreaticoduodenectomy for distal cholangiocarcinoma: surgical results, prognostic factors, and long-term follow-up

Andrianello

Paiella

Allegrini

et al. 2015

Langenbecks Arch Surg

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Section: Discussionmentioning

confidence: 65%

Pancreaticoduodenectomy for distal cholangiocarcinoma: surgical results, prognostic factors, and long-term follow-up

Andrianello

Paiella

Allegrini

et al. 2015

Langenbecks Arch Surg

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“…A positive resection margin has been considered as an adverse prognostic factor in some studies [6,7,11,13]; however, its prognostic impact has not been fully determined because of inconsistent results among studies and diverse definitions. Incidences of a positive resection margin in EHBD cancer after curative resection can vary from 10% to as high as 70%, which can be explained by differences between surgeons regarding the principle of the operation or the definition of a positive resection margin, such as whether to include carcinoma in situ [15-19].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Kim

Chie

et al. 2017

Cancer Res Treat

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PurposeThis study was conducted to evaluate the long-term outcome in patients undergoing pancreaticoduodenectomy (PD) followed by adjuvant chemoradiotherapy for distal cholangiocarcinoma (DCC) in a high-volume center and to identify the prognostic impact of clinicopathologic factors.Materials and MethodsA total of 132 consecutive patients who met the inclusion criteria were retrieved from the institutional database from January 1995 to September 2009. All patients received adjuvant treatments at a median of 45 days after the surgery. Median follow-up duration was 57 months (range, 6 to 225 months) for all patients and 105 months for survivors (range, 13 to 225 months).ResultsThe 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 70.7%, 55.7%, 49.4%, and 48.1%, respectively. Univariate analysis revealed poorly differentiated (P/D) tumors and lymph node (LN) metastasis were significantly associated with DMFS and OS. Additionally, preoperative carbohydrate antigen 19-9 level was significantly correlated with DFS, LRRFS, and DMFS. Upon multivariate analysis for OS, P/D tumors (p=0.015) and LN metastasis (p=0.003) were significant prognosticators that predicted inferior OS. Grade 3 or higher late gastrointestinal toxicity occurred in only one patient (0.8%).ConclusionAdjuvant chemoradiotherapy after PD for DCC is an effective and tolerable strategy without significant side effects. During long-term follow-up, we found that prognosis of DCC was mainly influenced by histologic differentiation and LN metastasis. For patients with these risk factors, further research should focus on improving adjuvant strategies as well as other treatment approaches.

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“…Although advances in radical surgical treatment in resectable cases of this malignancy improved the clinical outcomes, the 5-year survival rate was only 25-43%. Chemotherapy is not effective for palliative treatment in advanced cases; therefore, the median survival of patients with unresectable CCA was only 3-13 months (Nagino et al, 2008;Akamatsu et al, 2011;Van der Gaag et al, 2012). Regarding the data of poor treatment outcomes for unresectable CCA despite adjuvant chemotherapy or radiation treatment (Shin et al, 2010;Aslanian and Jamidar, 2011;Sangchan et al, 2012;Ruys et al, 2012), many patients preferred only palliative treatment, particularly biliary drainage.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Treatment Outcomes of Patients with Unresectable Cholangiocarcinoma in Thailand: Are there Differences Dependent on Stent Type?

Prachayakul

Chaisayan²,

Aswakul³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Cholangiocarcinoma, though very rare in Western countries, is one of the commonest liver malignancies in Southeast Asia, especially in Thailand. More than half of the patients present with advanced stage disease. Given the poor treatment outcomes of adjuvant therapeutic options, many patients undergo only biliary drainage for palliative treatment. Clinical characteristics and treatment outcomes after biliary stenting were here analyzed for a total of 224 uresectable cholangiocarcinoma cases, 58.9% in men. The mean age was 61.5 years. Hilar involvement was the most common location. The patients underwent biliary drainage using plastic and metallic stents equally, early stent occlusion being encountered in 21.4% and 10.7%, respectively. The median survival time was 4.93 months for patients who received plastic and 5.87 months for patients who received metallic stents.

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Survival analysis and prognostic nomogram for patients undergoing resection of extrahepatic cholangiocarcinoma

Cited by 89 publications

References 31 publications

Pancreaticoduodenectomy for distal cholangiocarcinoma: surgical results, prognostic factors, and long-term follow-up

Pancreaticoduodenectomy for distal cholangiocarcinoma: surgical results, prognostic factors, and long-term follow-up

Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Clinical Characteristics and Treatment Outcomes of Patients with Unresectable Cholangiocarcinoma in Thailand: Are there Differences Dependent on Stent Type?

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