Top

Annals of Surgical Oncology

Published in:

01-03-2007

Distal Bile Duct Carcinoma: Prognostic Factors After Curative Surgery. A Series of 112 Cases

Authors: Qingbao Cheng, Xiangji Luo, Baihe Zhang, Xiaoqing Jiang, Bin Yi, Mengchao Wu

Published in: Annals of Surgical Oncology | Issue 3/2007

Abstract

Background

The identification of independent prognostic indicators in distal bile duct carcinomas (DBDCs) has been limited by the small number of tumors and a lack of molecular prognostic markers. Markers assessed in combination may perform better than those considered individually. We conducted this study to identify prognostic predictors of patients with DBDC with special focus on combination of expression of p53 protein and clinicopathological predictors.

Methods

Between December 1996 and 2002, 112 consecutive patients undergoing pancreaticoduodenectomy in the Eastern Hepatobiliary Surgery Hospital for distal bile duct carcinomas were identified in a prospectively collected database. The survival of patients was comparable with respect to patient characteristics, clinicopathological factors and degree of p53 protein expression followed by a univariate and multivariate analysis.

Results

Actual 1, 3, and 5-year survival rates were 85.7, 50.9, and 25.0%, respectively. By Cox proportional hazards survival analysis, the most powerful predictors of survival rate were p53 expression [relative risk (RR) 5.2, 95% CI 4.8–5.6], pancreatic invasion (RR 5.6, 95% CI 4.3–6.9), lymph nodes metastasis (RR 3.9, 95% CI 3.3–4.5), and operative time (RR 1.8, 95% CI 1.5–2.1).

Conclusions

Overexpression of p53 in DBDC is strongly associated with significantly reduced survival, independently of clinicopathological prognostic factors. The resection margin status provides little independent prognostic information. Longer operative time may have unfavorable effect on prognosis of patients with DBDC.

Fong Y, Blumgart LH, Lin E, Fortner JG, Brennan MF. Outcome of treatment for distal bile duct cancer. Br J Surg 1996; 83:1712–15PubMedCrossRef

Andersen HB, Baden H, Brahe NE, Burcharth F. Pancreaticoduodenectomy for periampullary adenocarcinoma. J Am Coll Surg 1994; 179:545–52PubMed

Lerut JP, Gianello PR, Otte JB, Kestens PJ. Pancreaticoduodenal resection: Surgical experience and evaluation of risk factors in 103 patients. Ann Surg 1984; 199:432–7PubMedCrossRef

Jones BA, Langer B, Taylor BR, Girotti M. Periampullary tumors: which ones should be resected? Am J Surg 1985; 149:46–52PubMedCrossRef

Tarazi RY, Hermann RE, Vogt DP, et al. Results of surgical treatment of periampullary tumors: a thirty-five-year experience. Surgery 1986; 100:716–22PubMed

Chan C, Herrera MF, de la Garza L, et al. Clinical behavior and prognostic factors of periampullary adenocarcinoma. Ann Surg 1995; 222:632–7PubMedCrossRef

Tompkins RK, Thomas D, Wile A, Longmire WP Jr. Prognostic factors in bile duct carcinoma. Ann Surg 1981; 194:447–57PubMedCrossRef

Alexander F, Rossi RL, O’Bryan M, Khettry U, Braasch JW, Watkins E Jr. Biliary carcinoma: a review of 109 cases. Am J Surg 1984; 147:503–9PubMedCrossRef

Reding R, Buard JL, Lebeau G, Launois B. Surgical management of 552 carcinomas of the extrahepatic bile ducts (gallbladder and periampullary tumors excluded). Ann Surg 1991; 213:236–41PubMedCrossRef

10.

Nagorney DH, Donohue JH, Farnell MB, Schleck CD, Ilstrup DM. Outcomes after curative resections of cholangiocarcinoma. Arch Surg 1993; 128:871–9PubMed

11.

Rijken AM, Umezawa A, van Gulik TM, et al. Prognostic value of cell proliferation (Ki-67 antigen) and nuclear DNA content in clinically resectable, distal bile duct carcinoma. Ann Surg Oncol 1998; 5:699–705PubMedCrossRef

12.

Wade TP, Prasad CN, Virgo KS, Johnson FE. Experience with distal bile duct cancers in US Veterans Affairs hospitals: 1987–1991. J Surg Oncol 1997; 64:242–5PubMedCrossRef

13.

Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma: a spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 1996; 224:463–73PubMedCrossRef

14.

Launois B, Terblanche J, Lakehal M, et al. Proximal bile duct cancer: high resectability rate and 5-year survival. Ann Surg 1999; 230:266–75PubMedCrossRef

15.

Blom D, Schwartz SI. Surgical treatment and outcomes in carcinoma of the extrahepatic bile ducts: the University of Rochester experience. Arch Surg 2001; 136:209–15PubMedCrossRef

16.

Reed DN Jr, Vitale GC, Martin R, et al. Bile duct carcinoma: trends in treatment in the nineties. Am Surg 2000; 66:711–5PubMed

17.

Li L, Lemoe KD, Cameron JL. Surgery for hilar cholangiocarcinoma: the Johns Hopkins approach. J Hepatobiliary Pancreat Surg 2000; 7:115–121CrossRef

18.

Todoroki T, Koike N, Morishita Y, et al. Patterns and predictors of failure after curative resections of carcinoma of the ampulla of Vater. Ann Surg Oncol 2003; 10:1176–83PubMedCrossRef

19.

Yoshida T, Matsumoto T, Sasaki A, Morii Y, Aramaki M, Kitano S. Prognostic factors after pancreatoduodenectomy with extended lymphadenectomy for distal bile duct cancer. Arch Surg 2002; 137:69–73PubMedCrossRef

20.

Bortolasi L, Burgart LJ, Tsiotos GG, Luque-De Leon E, Sarr MG. Adenocarcinoma of the distal bile duct. A clinicopathologic outcome analysis after curative resection. Dig Surg 2000; 17:36–41PubMedCrossRef

21.

He P, Shi JS, Chen WK, Wang ZR, Ren H, Li H. Multivariate statistical analysis of clinicopathologic factors influencing survival of patients with bile duct carcinoma. World J Gastroenterol 2002; 8:943–6PubMed

22.

Yeo CJ, Sohn TA, Cameron JL, Hruban RH, Lillemoe KD, Pitt HA. Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 1998; 227:821–31PubMedCrossRef

23.

Brown JM, Wouters BG. Apoptosis, p53, and tumor cell sensitivity to anticancer agents. Cancer Res 1999; 59:1391–9PubMed

24.

Rich T, Allen RL, Wyllie AH. Defying death after DNA damage. Nature 2000; 407:777–83PubMedCrossRef

25.

Kinzler KW, Vogelstein B. Cancer therapy meets p53. N Engl J Med 1994;331:49–50PubMedCrossRef

26.

Lowe S, Bodis S, McClatchey A, et al. p53 Status and the efficacy of cancer therapy in vivo. Science 1994; 266:807–10PubMedCrossRef

27.

Thompson AM, Anderson TJ, Condie A, et al. p53 allele losses, mutations and expression in breast cancer and their relationship to clinico-pathological parameters. Int J Cancer 1992; 50:528–32PubMedCrossRef

28.

Quinlan DC, Davidson AG, Summers CL, Warden HE, Doshi HM. Accumulation of p53 protein correlates with a poor prognosis in human lung cancer. Cancer Res 1992; 52:4828–31PubMed

29.

Hamelin R, Laurent-Puig P, Olschwang S, et al. Association of p53 mutations with short survival in colorectal cancer. Gastroenterology 1994; 106:42–8PubMed

30.

Martin HM, Filipe MI, Morris RW, Lane DP, Silvestre F. p53 expression and prognosis in gastric carcinoma. Int J Cancer 1992; 50:859–62PubMedCrossRef

31.

Sobin LH, Wittekind C. TNM classification of malignant tumors, 5th edn. New York: Wiley, 1997

32.

Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138:8–13PubMedCrossRef

33.

Lane DP. Cancer: p53, guardian of the genome. Nature 1992; 358:15–6PubMedCrossRef

34.

Rijken AM, Offerhaus GJ, Polak MM, Gouma DJ, van Gulik TM. p53 expression as a prognostic determinant in resected distal bile duct carcinoma. Eur J Surg Oncol 1999; 25:297–301PubMedCrossRef

35.

Ajiki T, Kamigaki T, Hasegawa Y, et al. Proliferating cell nuclear antigen, p53, and c-erbB-2 expression in relation to clinicopathological variables and prognosis in cancer of the ampulla of Vater. Hepatogastroenterology 2001; 48:1266–70PubMed

36.

Klempnauer J, Ridder GJ, von Wasielewski R, Werner M, Weimann A, Pichlmayr R. Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 1997; 15:947–54PubMed

37.

Klempnauer J, Ridder GJ, Werner M, Weimann A, Pichlmayr R. What constitutes long-term survival after surgery for hilar cholangiocarcinoma? Cancer 1997; 79:26–34PubMedCrossRef

38.

Pichlmayr R, Weimann A, Klempnauer J, Oldhafer KJ, Maschek H, Tusch G, Ringe B. Surgical treatment in proximal bile duct cancer. A single-center experience. Ann Surg 1996; 224:628–38PubMedCrossRef

39.

Fortner JG, Vitelli CE, Maclean BJ. Proximal extrahepatic bile duct tumors. Analysis of a series of 52 consecutive patients treated over a period of 13 years. Arch Surg 1989; 124:1275–9PubMed

40.

Sasaki R, Takahashi M, Funato O, et al. Prognostic significance of lymph node involvement in middle and distal bile duct cancer. Surgery 2001; 129:677–83PubMedCrossRef

41.

Kayahara M, Nagakawa T, Ohta T, Kitagawa H, Tajima H, Miwa K. Role of nodal involvement and the periductal soft-tissue margin in middle and distal bile duct cancer. Ann Surg 1999; 229:76–83PubMedCrossRef

42.

Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002; 236:355–68PubMedCrossRef

43.

Kim S, Kim SW, Bang YJ, Heo DS, Ha SW. Role of postoperative radiotherapy in the management of extrahepatic bile duct cancer. Int J Radiat Oncol Biol Phys 2002; 54:414–9PubMedCrossRef

Title: Distal Bile Duct Carcinoma: Prognostic Factors After Curative Surgery. A Series of 112 Cases
Authors: Qingbao Cheng
Xiangji Luo
Baihe Zhang
Xiaoqing Jiang
Bin Yi
Mengchao Wu
Publication date: 01-03-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 3/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9260-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Distal Bile Duct Carcinoma: Prognostic Factors After Curative Surgery. A Series of 112 Cases

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2007

Letter to the Editor

Papillary Lesions: A Review of the Literature

The Utility of Intraoperative Evaluation of Sentinel Lymph Nodes in Breast Cancer

Evaluation of Three Scoring Systems Predicting Non Sentinel Node Metastasis in Breast Cancer Patients with a Positive Sentinel Node Biopsy

Timing of Resection of Liver Metastases Synchronous to Colorectal Tumor: Proposal of Prognosis-Based Decisional Model

Results of MRI Screening for Breast Cancer in High-Risk Patients with LCIS and Atypical Hyperplasia