TY - JOUR
T1 - The prognostic role of lymphovascular invasion and lymph node metastasis in perihilar and intrahepatic cholangiocarcinoma
AU - Lurje, Georg
AU - Bednarsch, Jan
AU - Czigany, Zoltan
AU - Lurje, Isabella
AU - Schlebusch, Ivana Katharina
AU - Boecker, Joerg
AU - Meister, Franziska Alexandra
AU - Tacke, Frank
AU - Roderburg, Christoph
AU - Den Dulk, Marcel
AU - Gaisa, Nadine Therese
AU - Bruners, Philipp
AU - Neumann, Ulf Peter
N1 - Funding Information:
This research project is supported by the START-Program (# 136/17 ) of the Faculty of Medicine, RWTH Aachen and funded by the Excellence Initiative of the German federal and state governments ( G:(DE-82) ZUK2-SF-OPSF486 ).
Publisher Copyright:
© 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2019/8
Y1 - 2019/8
N2 - Introduction: Cholangiocellular carcinoma (CCA) is an aggressive malignancy with a dismal prognosis. Among curative treatment options for CCA, radical surgical resection with extrahepatic bile duct resection, hepatectomy and en-bloc lymphadenectomy are considered the mainstay of curative therapy. Here, we aimed to identify prognostic markers of clinical outcome in CCA-patients who underwent surgical resection in curative intent.Material and methods: Between 2011 and 2016, 162 patients with CCA (perihilar CCA (pCCA): n = 91, intrahepatic CCA (iCCA): n = 71) underwent surgery in curative intent at our institution. Preoperative characteristics, perioperative data and oncological follow-up were obtained from a prospectively managed institutional database. The associations of overall-(OS) and disease-free-survival (DFS) with clinico-pathological characteristics were assessed using univariate and multivariable cox regression analyses.Results: The median OS and DFS were 38 and 36 months for pCCA and 25 and 13 months for iCCA, respectively. Lymphovascular invasion (LVI) and lymph node metastasis as well as surgical complications as assessed by the comprehensive complication index (CCI) and tumor grading were independently associated with OS for the pCCA (LVI; RR = 2.36, p = 0.028; CCI; RR = 1.04, p <0.001) and iCCA cohorts (N-category; RR = 3.21, p = 0.040; tumor grading; RR = 3.75, p = 0.013; CCI, RR = 4.49, p = 0.010), respectively. No other clinical variable including R0-status and Bismuth classification was associated with OS.Conclusion: Major liver resections for CCA are feasible and safe in experienced high-volume centers. Lymph node metastasis and LVI are associated with adverse clinical outcome, supporting the role of systematic lymphadenectomy. The assessment of LVI may be useful in identifying high-risk patients for adjuvant treatment strategies. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
AB - Introduction: Cholangiocellular carcinoma (CCA) is an aggressive malignancy with a dismal prognosis. Among curative treatment options for CCA, radical surgical resection with extrahepatic bile duct resection, hepatectomy and en-bloc lymphadenectomy are considered the mainstay of curative therapy. Here, we aimed to identify prognostic markers of clinical outcome in CCA-patients who underwent surgical resection in curative intent.Material and methods: Between 2011 and 2016, 162 patients with CCA (perihilar CCA (pCCA): n = 91, intrahepatic CCA (iCCA): n = 71) underwent surgery in curative intent at our institution. Preoperative characteristics, perioperative data and oncological follow-up were obtained from a prospectively managed institutional database. The associations of overall-(OS) and disease-free-survival (DFS) with clinico-pathological characteristics were assessed using univariate and multivariable cox regression analyses.Results: The median OS and DFS were 38 and 36 months for pCCA and 25 and 13 months for iCCA, respectively. Lymphovascular invasion (LVI) and lymph node metastasis as well as surgical complications as assessed by the comprehensive complication index (CCI) and tumor grading were independently associated with OS for the pCCA (LVI; RR = 2.36, p = 0.028; CCI; RR = 1.04, p <0.001) and iCCA cohorts (N-category; RR = 3.21, p = 0.040; tumor grading; RR = 3.75, p = 0.013; CCI, RR = 4.49, p = 0.010), respectively. No other clinical variable including R0-status and Bismuth classification was associated with OS.Conclusion: Major liver resections for CCA are feasible and safe in experienced high-volume centers. Lymph node metastasis and LVI are associated with adverse clinical outcome, supporting the role of systematic lymphadenectomy. The assessment of LVI may be useful in identifying high-risk patients for adjuvant treatment strategies. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
KW - Cholangiocarcinoma (CCA)
KW - Disease-free survival (DFS)
KW - Overall survival (OS)
KW - Lymphovascular invasion (LVI)
KW - POSITRON-EMISSION-TOMOGRAPHY
KW - PERINEURAL INVASION
KW - SURGICAL RESECTION
KW - CANCER PATIENTS
KW - RISK-FACTORS
KW - SURVIVAL
KW - CHEMOTHERAPY
KW - RECURRENCE
KW - MANAGEMENT
KW - THERAPY
U2 - 10.1016/j.ejso.2019.04.019
DO - 10.1016/j.ejso.2019.04.019
M3 - Article
C2 - 31053477
SN - 0748-7983
VL - 45
SP - 1468
EP - 1478
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 8
ER -