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01-08-2021 | Cholangiocarcinoma | Hepatobiliary Tumors

Defining the Risk of Early Recurrence Following Curative-Intent Resection for Distal Cholangiocarcinoma

Authors: Kota Sahara, MD, Diamantis I. Tsilimigras, MD, Junya Toyoda, MD, Kentaro Miyake, MD, PhD, Cecilia G. Ethun, MD, Shishir K. Maithel, MD, Daniel E. Abbott, MD, George A. Poultsides, MD, Ioannis Hatzaras, MD, Ryan C. Fields, MD, Matthew Weiss, MD, Charles Scoggins, MD, Chelsea A. Isom, MD, Kamran Idrees, MD, Perry Shen, MD, Yasuhiro Yabushita, MD, PhD, Ryusei Matsuyama, MD, PhD, Itaru Endo, MD, PhD, Timothy M. Pawlik, MD, MPH, MTS, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 8/2021

Abstract

Background

Although multidisciplinary treatments including the use of adjuvant therapy (AT) have been adopted for biliary tract cancers, patients with distal cholangiocarcinoma (DCC) can still experience recurrence. We sought to characterize the incidence and predictors of early recurrence (ER) that occurred within 12 months following surgery for DCC.

Patients and Methods

Patients who underwent resection for DCC between 2000 and 2015 were identified from the US multi-institutional database. Cox regression analysis was used to identify clinicopathological factors to develop an ER risk score, and the predictive model was validated in an external dataset.

Results

Among 245 patients included in the analysis, 67 patients (27.3%) developed ER. No difference was noted in ER rates between patients who did and did not receive AT (28.7% vs. 25.0%, p = 0.55). Multivariable analysis revealed that neutrophil-to-lymphocyte ratio (NLR), peak total bilirubin (T-Bil), major vascular resection (MVR), lymphovascular invasion, and R1 surgical margin status were associated with a higher ER risk. A DIstal Cholangiocarcinoma Early Recurrence Score was developed according to each factor available prior to surgery [NLR > 9.0 (2 points); peak T-bil > 1.5 mg/dL (1 points); MVR (2 points)]. Cumulative ER rates incrementally increased among patients who were low (0 points; 10.6%), intermediate (1–2 points; 26.8%), or high (3–5 points; 57.6%) risk (p < 0.001) in the training dataset, as well as in the validation dataset [low (0 points); 3.4%, intermediate (1–2 points); 32.7%, or high risk (3–5 points); 55.6% (p < 0.001)].

Conclusions

Among patients undergoing resection for DCC, 1 in 4 patients experienced an ER. Alternative treatment strategies such as neoadjuvant chemotherapy may be considered especially among individuals deemed to be at high risk for ER.

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Title: Defining the Risk of Early Recurrence Following Curative-Intent Resection for Distal Cholangiocarcinoma
Authors: Kota Sahara, MD
Diamantis I. Tsilimigras, MD
Junya Toyoda, MD
Kentaro Miyake, MD, PhD
Cecilia G. Ethun, MD
Shishir K. Maithel, MD
Daniel E. Abbott, MD
George A. Poultsides, MD
Ioannis Hatzaras, MD
Ryan C. Fields, MD
Matthew Weiss, MD
Charles Scoggins, MD
Chelsea A. Isom, MD
Kamran Idrees, MD
Perry Shen, MD
Yasuhiro Yabushita, MD, PhD
Ryusei Matsuyama, MD, PhD
Itaru Endo, MD, PhD
Timothy M. Pawlik, MD, MPH, MTS, PhD, FACS
Publication date: 01-08-2021
Publisher: Springer International Publishing
Keywords: Cholangiocarcinoma
Cholangiocarcinoma
Published in: Annals of Surgical Oncology / Issue 8/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-09811-4

At a glance: The STEP trials

Springer Medicine

Defining the Risk of Early Recurrence Following Curative-Intent Resection for Distal Cholangiocarcinoma

Abstract

Background

Patients and Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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