The prognostic role of lymphovascular invasion and lymph node metastasis in perihilar and intrahepatic cholangiocarcinoma

Lurje, Georg; Bednarsch, Jan; Czigány, Zoltán; Lurje, Isabella; Schlebusch, Ivana Katharina; Boecker, Joerg; Meister, Franziska; Tacke, Frank; Roderburg, Christoph; Dulk, Marcel den; Gaisa, Nadine T.; Bruners, Philipp; Neumann, Ulf

doi:10.1016/j.ejso.2019.04.019

Cited by 58 publications

(87 citation statements)

References 36 publications

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“…In this retrospective cohort study, surgery with curative intent for pCCA was associated with 5- and 10-year OS rates of 33% and 19%, and with 5- and 10-year DFS rates of 37% and 30%, respectively. These results are in line with current literature [ 5 , 7 , 13 , 19 – 29 ]. The 5-year OS rates of these larger series range from 22 to 44%.…”

Section: Discussionsupporting

confidence: 93%

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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: Discussionsupporting

confidence: 93%

“…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%

Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma

et al. 2020

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“…Meanwhile, we noticed something different that in certain tumor types, especially cholangiocarcinoma, CA242 levels in LNM were signi cantly higher than DM (Table 2). Numerous studies have shown that LNM is one of the most prominent prognostic factors associated with poor prognosis for cholangiocarcinoma patients [33].…”

Section: Discussionmentioning

confidence: 99%

Serum CA242: a biomarker for diagnosis, progression, and metastasis in multiple tumors

Shen

Qin

et al. 2020

Preprint

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BackgroundCA242 is a classic biomarker used for diagnosing digestive tract tumors, especially pancreatic cancer. However, CA242 serum levels in some tumor patients and what might influence these levels remain unknown or uncertain. This study aimed to reveal the pancancer landscape of serum CA242 levels and identify some influencing factors.MethodsIn the current study, serum CA242 levels and clinical information, including clinical stage and metastatic status, were collected from 37,493 patients with 35 different types of neoplastic disease, and CA242 values were also obtained for 880 healthy controls.ResultsSerum CA242 levels in patients with one of 21 different cancers were significantly higher than those in healthy controls and had diagnostic value in 9 tumors (AUC>0.7, P<0.05); serum CA242 levels were increased across all malignant digestive tract tumors. Compared to patients without metastasis, cancer patients with one of 15 kinds of cancer with lymph node metastasis and distant metastasis showed elevated CA242 levels. Moreover, CA242 was helpful in distinguishing the clinical stage and metastatic status in 6 cancers. In addition, the presence of multiple metastases and liver metastasis might result in increased CA242 levels.ConclusionsOverall, CA242 can not only serve as a diagnostic biomarker for malignant tumors in the digestive system but also predict the progression, stage, and metastasis of many other tumors that have not received clinical attention.

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“…56 Other prognostic factors including age, lymph node status, TNM or tumor stage, tumor differentiation, perineural and vascular invasion, and hepatic resection have also been pointed out in many reports. 7,15,[57][58][59][60][61] Negative histologic margins, concomitant partial hepatectomy and portal vein resection, and well-differentiated tumor histology are associated with improved outcome after surgery, while increasing T-stage significantly correlated with reduced R0 resection rate, higher distant metastasis rate, and lower median survival. In addition, advanced age, lymph node involvement microvascular or perineural invasion and poor differentiation are poor prognosis factors.…”

Section: Prognostic Factorsmentioning

confidence: 99%

<p>The Significance of Adjuvant Therapy for Extrahepatic Cholangiocarcinoma After Surgery</p>

Wang

Xia

et al. 2019

CMAR

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Extrahepatic cholangiocarcinoma (EHCC) is a rare malignant tumor, and current treatment methods are also relatively limited. Radical surgery is the only potentially curative method for the long survival time. However, despite undergoing radical resection, prognosis remained poor due to the high recurrence rate and distant metastasis. Therefore, adjuvant chemotherapy and radiotherapy should be offered to patients who have undergone surgery. Unfortunately, the low incidence of this disease has resulted in a lack of high-level evidence to confirm the importance of adjuvant chemotherapy or radiotherapy. At present, it is still controversial whether adjuvant therapy can prolong the survival of patients after operation, especially patients with negative margins or lymph nodes. Furthermore, standard regimens of adjuvant have not been identified. This review summarizes the currently available evidence of the effect of adjuvant therapy in the management of EHCC. Ultimately, we concluded that adjuvant therapy may improve survival in high-risk (positive margin or lymph node or advanced stage) patients and adjuvant concurrent chemoradiotherapy followed by chemotherapy may be the optimum selection for them. This needs to be verified by randomized prospective clinical trials.

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The prognostic role of lymphovascular invasion and lymph node metastasis in perihilar and intrahepatic cholangiocarcinoma

Cited by 58 publications

References 36 publications

Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma

Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma

Serum CA242: a biomarker for diagnosis, progression, and metastasis in multiple tumors

<p>The Significance of Adjuvant Therapy for Extrahepatic Cholangiocarcinoma After Surgery</p>

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