The clinicopathological factors associated with prognosis of patients with resectable perihilar cholangiocarcinoma

Tang, Zengwei; Yang, Yuan; Zhao, Zhonghong; Wei, Kongyuan; Meng, Wenbo; Li, Xun

doi:10.1097/md.0000000000011999

Cited by 41 publications

(34 citation statements)

References 49 publications

(279 reference statements)

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“…The negative impact of locoregional LNM on survival has already been well-established [ 4 , 8 , 9 , 19 , 23 , 25 , 27 , 29 – 36 ]. In the current study, the 5-year DFS of patients without LNM was 55%, compared to 12% of patients with LNM.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the series of Buettner et al, patients with LNM who underwent a resection still seem to have a better survival after resection compared to patients without surgery [ 36 ]. The pT-stage of the AJCC/UICC TNM-staging system was already identified as a prognostic factor [ 4 , 8 , 9 , 20 , 23 , 29 , 32 ]. In our cohort, pT-stage was a predictor of OS, but had no effect on DFS.…”

Section: Discussionmentioning

confidence: 99%

“…Radical surgical resection is the only curative option but has a high postoperative morbidity and mortality rate. The 5-year overall survival (OS) ranges from 13 to 42% for resectable pCCA [ 4 ], whereas the median OS of patients with unresectable pCCA is about 12 months with no survivors at 5 years [ 5 ]. The poor survival rates after potentially curative surgery are due to cancer recurrence as a result of the aggressive biological behaviour of pCCA with early hematogenous, lymphatic, and perineural spread of cancer cells [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma

et al. 2020

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Background Several clinicopathological predictors of survival after curative surgery for perihilar cholangiocarcinoma (pCCA) have been identified; however, conflicting reports remain. The aim was to analyse clinical and oncological outcomes after curative resection of pCCA and to determine prognostic factors. Methods Eighty-eight consecutive patients with pCCA underwent surgery with curative intent between 1998 and 2017. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Twenty-one prognostic factors were evaluated using multivariate Cox regression models. Results Postoperative complications were observed in 73 (83%) patients of which 41 (47%) were severe complications (therapy-oriented severity grading system (TOSGS) grade > 2), including a 90-day mortality of 9% (n = 8). Overall survival (OS) and disease-free survival (DFS) rates at 5 and 10 years after surgery were 33% and 19%, and 37% and 30%, respectively. Independent predictors of OS were locoregional lymph node metastasis (LNM) (risk ratio (RR) 2.12, confidence interval (CI) 1.19–3.81, p = 0.011), patient American Society of Anesthesiologists (ASA) physical status classification system > 2 (RR 2.10, CI 1.03–4.26, p = 0.043), and depth of tumour penetration (pT) > 2 (RR 2.58, CI 1.03–6.30, p = 0.043). The presence of locoregional LNM (RR 2.95, CI 1.51–5.90, p = 0.002) and caudate lobe resection (RR 2.19, CI 1.01–5.14, p = 0.048) were found as independent predictors of DFS. Conclusions Curative surgery for pCCA carries high risks with poor long-term survival. Locoregional LNM was the only predictor for both OS and DFS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma

et al. 2020

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“…This is why predicting long-term survival can be challenging, and accurate stratification of patient prognosis remains difficult [ 11 , 14 , 15 ]. In this context, physicians try to determine long-term survival by different prognostic tools that integrate the most relevant clinicopathological factors [ 6 , 7 , 14 , 16 , 17 , 18 ]. This includes the Bismuth-Corlette classification and the Blumgart T-stage system, which focus on determining resectability using preoperative imaging [ 7 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Relevance of the Eighth Edition of TNM Classification for Resected Perihilar Cholangiocarcinoma

Hau

Meyer

Jahn

et al. 2020

JCM

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Objectives: In our study, we evaluated and compared the prognostic value and performance of the 6th, 7th, and 8th editions of the American Joint Committee on Cancer (AJCC) staging system in patients undergoing surgery for perihilar cholangiocarcinoma (PHC). Methods: Patients undergoing liver surgery with curative intention for PHC between 2002 and 2019 were identified from a prospective database. Histopathological parameters and stage of the PHC were assessed according to the 6th, 7th, and 8th editions of the tumor node metastasis (TNM) classification. The prognostic accuracy between staging systems was compared using the area under the receiver operating characteristic curve (AUC) model. Results: Data for a total of 95 patients undergoing liver resection for PHC were analyzed. The median overall survival time was 21 months (95% CI 8.1–33.9), and the three- and five-year survival rates were 46.1% and 36.2%, respectively. Staging according to the 8th edition vs. the 7th edition resulted in the reclassification of 25 patients (26.3%). The log-rank p-values for the 7th and 8th editions were highly statistically significant (p ≤ 0.01) compared to the 6th edition (p = 0.035). The AJCC 8th edition staging system showed a trend to better discrimination, with an AUC of 0.69 (95% CI: 0.52–0.84) compared to 0.61 (95% CI: 0.51–0.73) for the 7th edition. Multivariate survival analysis revealed male gender, age >65 years, positive resection margins, presence of distant metastases, poorly tumor differentiation, and lymph node involvement, such as no caudate lobe resection, as independent predictors of poor survival (p < 0.05). Conclusions: In the current study, the newly released 8th edition of AJCC staging system showed no significant benefit compared to the previous 7th edition in predicting the prognosis of patients undergoing liver resection for perihilar cholangiocarcinoma. Further research may help to improve the prognostic value of the AJCC staging system for PHC—for instance, by identifying new prognostic markers or staging criteria, which may improve that individual patient’s outcome.

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“…PHC has a large number of factors associated with its prognosis, and yet prediction of long-term survival can be difficult to determine and accurate stratification of patient prognosis remains challenging [11,14,15]. Several prognostic schemes have attempted to aggregate the most relevant clinicopathological factors to provide estimates of long-term survival [6,7,14,[16][17][18]. Commonly used prognostic tools include the Bismuth-Corlette classification and the Blumgart Tstage system, which focus on determining resectability using preoperative imaging [7,19,20].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Accuracy of the Eighth Edition of TNM Classification Compared with the Seventh and Sixth Edition for Perihilar Cholangiocarcinoma

Hau¹,

Meyer

Rademacher

et al. 2020

Preprint

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Background This study was conducted to evaluate and compare the prognostic value and performance of the 6th, 7th, and 8th editions of the American Joint Committee on Cancer (AJCC) staging system when applied to patients undergoing surgery for perihilar cholangiocarcinoma (PHC). Methods Patients undergoing liver resection with curative intention for PHC between 2002 and 2019 were identified from a prospective database. Histopathological parameters and stage of the PHC were assessed according to the 6th, 7th, and 8th editions of the tumor node metastasis (TNM) classification. The prognostic accuracy between staging systems was compared using the area under the receiver operating characteristic curve (AUC) model. Results Data for a total of 95 patients undergoing liver resection for PHC were analyzed. The median overall survival time was 21 months (95% CI 8.1–33.9), and the 3- and 5-year survival rates were 46.1% and 36.2%, respectively. Staging according to the 8th edition versus the 7th edition resulted in reclassification of 25 patients (26.3%). The log-rank p-values for the 7th and 8th edition were highly statistically significant (p ≤ 0.01) compared to the 6th edition (p = 0.035). The AJCC 8th edition staging system had a slightly better discrimination ability, with an AUC of 0.69 (95% CI: 0.52–0.84) compared to 0.61 (95% CI: 0.51–0.73) for the 7th edition. Multivariate survival analysis revealed male gender, age > 65 years, positive resection margins, presence of distant metastases, poorly tumor differentiation, lymph node involvement such as no caudate lobe resection as independent predictors of poor survival (p < 0.05). Conclusion The newly released 8th edition of the AJCC staging system demonstrated a poor to moderate ability to predict prognosis of patients undergoing liver resection for perihilar cholangiocarcinoma; the result was only slightly better than the previous 7th edition. Further refinements are needed to improve the prognostic ability of the AJCC staging system for perihilar cholangiocarcinoma and to identify other prognostic factors that can potentially improve individual patient prognostication.

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The clinicopathological factors associated with prognosis of patients with resectable perihilar cholangiocarcinoma

Abstract: Supplemental Digital Content is available in the text

Cited by 41 publications

References 49 publications

Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma

Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma

Prognostic Relevance of the Eighth Edition of TNM Classification for Resected Perihilar Cholangiocarcinoma

Prognostic Accuracy of the Eighth Edition of TNM Classification Compared with the Seventh and Sixth Edition for Perihilar Cholangiocarcinoma

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