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World Journal of Surgery
Published in: World Journal of Surgery 9/2018

01-09-2018 | Original Scientific Report

Defining Early Recurrence of Hilar Cholangiocarcinoma After Curative-intent Surgery: A Multi-institutional Study from the US Extrahepatic Biliary Malignancy Consortium

Authors: Xu-Feng Zhang, Eliza W. Beal, Jeffery Chakedis, Qinyu Chen, Yi Lv, Cecilia G. Ethun, Ahmed Salem, Sharon M. Weber, Thuy Tran, George Poultsides, Andre Y. Son, Ioannis Hatzaras, Linda Jin, Ryan C. Fields, Stefan Buettner, Charles Scoggins, Robert C. G. Martin, Chelsea A. Isom, Kamron Idrees, Harveshp D. Mogal, Perry Shen, Shishir K. Maithel, Carl R. Schmidt, Timothy M. Pawlik

Published in: World Journal of Surgery | Issue 9/2018

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Abstract

Background

Time to tumor recurrence may be associated with outcomes following resection of hepatobiliary cancers. The objective of the current study was to investigate risk factors and prognosis among patients with early versus late recurrence of hilar cholangiocarcinoma (HCCA) after curative-intent resection.

Methods

A total of 225 patients who underwent curative-intent resection for HCCA were identified from 10 academic centers in the USA. Data on clinicopathologic characteristics, pre-, intra-, and postoperative details and overall survival (OS) were analyzed. The slope of the curves identified by linear regression was used to categorize recurrences as early versus late.

Results

With a median follow-up of 18.0 months, 99 (44.0%) patients experienced a tumor recurrence. According to the slope of the curves identified by linear regression, the functions of the two straight lines were y = −0.465x + 16.99 and y = −0.12x + 7.16. The intercept value of the two lines was 28.5 months, and therefore, 30 months (2.5 years) was defined as the cutoff to differentiate early from late recurrence. Among 99 patients who experienced recurrence, the majority (n = 80, 80.8%) occurred within the first 2.5 years (early recurrence), while 19.2% of recurrences occurred beyond 2.5 years (late recurrence). Early recurrence was more likely present as distant disease (75.1% vs. 31.6%, p = 0.001) and was associated with a worse OS (Median OS, early 21.5 vs. late 50.4 months, p < 0.001). On multivariable analysis, poor tumor differentiation (HR 10.3, p = 0.021), microvascular invasion (HR 3.3, p = 0.037), perineural invasion (HR 3.9, p = 0.029), lymph node metastases (HR 5.0, p = 0.004), and microscopic positive margin (HR 3.5, p = 0.046) were independent risk factors associated with early recurrence.

Conclusions

Early recurrence of HCCA after curative resection was common (~35.6%). Early recurrence was strongly associated with aggressive tumor characteristics, increased risk of distant metastatic recurrence and a worse long-term survival.
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Metadata
Title
Defining Early Recurrence of Hilar Cholangiocarcinoma After Curative-intent Surgery: A Multi-institutional Study from the US Extrahepatic Biliary Malignancy Consortium
Authors
Xu-Feng Zhang
Eliza W. Beal
Jeffery Chakedis
Qinyu Chen
Yi Lv
Cecilia G. Ethun
Ahmed Salem
Sharon M. Weber
Thuy Tran
George Poultsides
Andre Y. Son
Ioannis Hatzaras
Linda Jin
Ryan C. Fields
Stefan Buettner
Charles Scoggins
Robert C. G. Martin
Chelsea A. Isom
Kamron Idrees
Harveshp D. Mogal
Perry Shen
Shishir K. Maithel
Carl R. Schmidt
Timothy M. Pawlik
Publication date
01-09-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 9/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4530-0

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