Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized Disease.

Journal

Annals of surgical oncology

ISSN: 1534-4681

Titre abrégé: Ann Surg Oncol

Pays: United States

ID NLM: 9420840

Informations de publication

Date de publication:
19 Jun 2024

Historique:

received: 14 03 2024

accepted: 20 05 2024

medline: 19 6 2024

pubmed: 19 6 2024

entrez: 19 6 2024

Statut: aheadofprint

Résumé

Resection of perihilar cholangiocarcinoma (pCCA) is a complex procedure with a high risk of postoperative mortality and early disease recurrence. The objective of this study was to compare patient characteristics and overall survival (OS) between pCCA patients who underwent an R1 resection and patients with localized pCCA who received palliative systemic chemotherapy. Patients with a diagnosis of pCCA between 1997-2021 were identified from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry. pCCA patients who underwent an R1 resection were compared with patients with localized pCCA (i.e., nonmetastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy. The primary outcome was OS. Overall, 146 patients in the R1 resection group and 92 patients in the palliative chemotherapy group were included. The palliative chemotherapy group more often underwent biliary drainage (95% vs. 66%, p < 0.001) and had more vascular encasement on imaging (70% vs. 49%, p = 0.012) and CA 19.9 was more frequently >200 IU/L (64 vs. 45%, p = 0.046). Median OS was comparable between both groups (17.1 vs. 16 months, p = 0.06). Overall survival at 5 years after diagnosis was 20.0% with R1 resection and 2.2% with chemotherapy. Type of treatment (i.e., R1 resection or palliative chemotherapy) was not an independent predictor of OS (hazard ratio 0.76, 95% confidence interval 0.55-1.07). Palliative systemic chemotherapy should be considered instead of resection in patients with a high risk of both R1 resection and postoperative mortality.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Patients with a diagnosis of pCCA between 1997-2021 were identified from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry. pCCA patients who underwent an R1 resection were compared with patients with localized pCCA (i.e., nonmetastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy. The primary outcome was OS.

RESULTS RESULTS

Overall, 146 patients in the R1 resection group and 92 patients in the palliative chemotherapy group were included. The palliative chemotherapy group more often underwent biliary drainage (95% vs. 66%, p < 0.001) and had more vascular encasement on imaging (70% vs. 49%, p = 0.012) and CA 19.9 was more frequently >200 IU/L (64 vs. 45%, p = 0.046). Median OS was comparable between both groups (17.1 vs. 16 months, p = 0.06). Overall survival at 5 years after diagnosis was 20.0% with R1 resection and 2.2% with chemotherapy. Type of treatment (i.e., R1 resection or palliative chemotherapy) was not an independent predictor of OS (hazard ratio 0.76, 95% confidence interval 0.55-1.07).

CONCLUSIONS CONCLUSIONS

Palliative systemic chemotherapy should be considered instead of resection in patients with a high risk of both R1 resection and postoperative mortality.

Identifiants

DOI: 10.1245/s10434-024-15582-5 PMID: 38896226

pubmed: 38896226

doi: 10.1245/s10434-024-15582-5

pii: 10.1245/s10434-024-15582-5

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

Khan SA, Tavolari S, Brandi G. Cholangiocarcinoma: epidemiology and risk factors. Liver Int. 2019;39(Suppl 1):19–31.

doi: 10.1111/liv.14095

Popescu I, Dumitrascu T. Curative-intent surgery for hilar cholangiocarcinoma: prognostic factors for clinical decision making. Langenbecks Arch Surg. 2014;399(6):693–705.

doi: 10.1007/s00423-014-1210-x

Cho MS, Kim SH, Park SW, Lim JH, Choi GH, Park JS, et al. Surgical outcomes and predicting factors of curative resection in patients with hilar cholangiocarcinoma: 10-year single-institution experience. J Gastrointest Surg. 2012;16(9):1672–9.

doi: 10.1007/s11605-012-1960-0

Nuzzo G, Giuliante F, Ardito F, Giovannini I, Aldrighetti L, Belli G, et al. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg. 2012;147(1):26–34.

doi: 10.1001/archsurg.2011.771

van Keulen AM, Franssen S, van der Geest LG, de Boer MT, Coenraad M, van Driel L, et al. Nationwide treatment and outcomes of perihilar cholangiocarcinoma. Liver Int. 2021;41(8):1945–53.

doi: 10.1111/liv.14856

Cillo U, Fondevila C, Donadon M, Gringeri E, Mocchegiani F, Schlitt HJ, et al. Surgery for cholangiocarcinoma. Liver Int. 2019;39(Suppl):143–55.

doi: 10.1111/liv.14089

van Keulen AM, Olthof PB, Cescon M, Guglielmi A, Jarnagin WR, Nadalin S, et al. Actual 10-year survival after resection of perihilar cholangiocarcinoma: what factors preclude a chance for cure? Cancers (Basel). 2021;13(24):6260.

doi: 10.3390/cancers13246260

DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007;245(5):755–62.

doi: 10.1097/01.sla.0000251366.62632.d3

Serrablo A, Tejedor L. Outcome of surgical resection in Klatskin tumors. World J Gastrointest Oncol. 2013;5(7):147–58.

doi: 10.4251/wjgo.v5.i7.147

Capobianco I, Rolinger J, Nadalin S. Resection for Klatskin tumors: technical complexities and results. Transl Gastroenterol Hepatol. 2018;3:69.

doi: 10.21037/tgh.2018.09.01

de Jong MC, Marques H, Clary BM, Bauer TW, Marsh JW, Ribero D, et al. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer. 2012;118(19):4737–47.

doi: 10.1002/cncr.27492

Nakanishi Y, Tsuchikawa T, Okamura K, Nakamura T, Tamoto E, Murakami S, et al. Prognostic impact of the site of portal vein invasion in patients with surgically resected perihilar cholangiocarcinoma. Surgery. 2016;159(6):1511–9.

doi: 10.1016/j.surg.2016.01.012

D’Amico FE, Mescoli C, Caregari S, Pasquale A, Billato I, Alessandris R, et al. Impact of positive radial margin on recurrence and survival in perihilar cholangiocarcinoma. Cancers (Basel). 2022;14(7):2389.

Hau HM, Meyer F, Jahn N, Rademacher S, Sucher R, Seehofer D. Prognostic relevance of the eighth edition of TNM classification for resected perihilar cholangiocarcinoma. J Clin Med. 2020;9(10):3152.

doi: 10.3390/jcm9103152

Farges O, Regimbeau JM, Fuks D, Le Treut YP, Cherqui D, Bachellier P, et al. Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma. Br J Surg. 2013;100(2):274–83.

doi: 10.1002/bjs.8950

van Keulen AM, Buettner S, Erdmann JI, Pratschke J, Ratti F, Jarnagin WR, et al. Multivariable prediction model for both 90-day mortality and long-term survival for individual patients with perihilar cholangiocarcinoma: does the predicted survival justify the surgical risk? Br J Surg. 2023;110(5):599–605.

doi: 10.1093/bjs/znad057

Franken LC, Coelen RJS, Erdmann JI, Verheij J, Kop MP, van Gulik TM, et al. Multidetector computed tomography assessment of vascular involvement in perihilar cholangiocarcinoma. Quant Imaging Med Surg. 2021;11(11):4514–21.

doi: 10.21037/qims-20-1303

Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–81.

doi: 10.1056/NEJMoa0908721

Caillol F, Bories E, Zemmour C, Pesenti C, Ratone JP, Gilabert M, et al. Palliative endoscopic drainage of malignant stenosis of biliary confluence: Efficiency of multiple drainage approach to drain a maximum of liver segments. United European Gastroenterol J. 2019;7(1):52–9.

doi: 10.1177/2050640618803812

Casadio M, Cardinale V, Klümpen HJ, Morement H, Lacasta A, Koerkamp BG, et al. Setup of multidisciplinary team discussions for patients with cholangiocarcinoma: current practice and recommendations from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). ESMO Open. 2022;7(1):100377.

doi: 10.1016/j.esmoop.2021.100377

Banales JM, Cardinale V, Carpino G, Marzioni M, Andersen JB, Invernizzi P, et al. Expert consensus document: cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nat Rev Gastroenterol Hepatol. 2016;13(5):261–80.

doi: 10.1038/nrgastro.2016.51

Liao X, Zhang D. The 8th Edition American Joint Committee on Cancer Staging for Hepato-pancreato-biliary cancer: a review and update. Arch Pathol Lab Med. 2021;145(5):543–53.

doi: 10.5858/arpa.2020-0032-RA

Gaspersz MP, Buettner S, Roos E, van Vugt JLA, Coelen RJS, Vugts J, et al. A preoperative prognostic model to predict surgical success in patients with perihilar cholangiocarcinoma. J Surg Oncol. 2018;118(3):469–76.

doi: 10.1002/jso.25174

Wiggers JK, Groot Koerkamp B, Cieslak KP, Doussot A, van Klaveren D, Allen PJ, et al. J Am Coll Surg. 2016;223(2):321–31.

doi: 10.1016/j.jamcollsurg.2016.03.035

Groot Koerkamp B, Wiggers JK, Gonen M, Doussot A, Allen PJ, Besselink MGH, et al. Survival after resection of perihilar cholangiocarcinoma-development and external validation of a prognostic nomogram. Ann Oncol. 2015;26(9):1930–5.

doi: 10.1093/annonc/mdv279

Buettner S, van Vugt JLA, Gaspersz MP, Coelen RJS, Roos E, Labeur TA, et al. Survival after resection of perihilar cholangiocarcinoma in patients with lymph node metastases. HPB (Oxford). 2017;19(8):735–40.

doi: 10.1016/j.hpb.2017.04.014

Nooijen LE, Banales JM, de Boer MT, Braconi C, Folseraas T, Forner A, et al. Impact of positive lymph nodes and resection margin status on the overall survival of patients with resected perihilar cholangiocarcinoma: The ENSCCA Registry. Cancers (Basel). 2022;14(10):2389.

doi: 10.3390/cancers14102389

Hartog H, Ijzermans JN, van Gulik TM, Groot Koerkamp B. Resection of perihilar cholangiocarcinoma. Surg Clin North Am. 2016;96(2):247–67.

doi: 10.1016/j.suc.2015.12.008

Serrablo A, Serrablo L, Alikhanov R, Tejedor L. Vascular resection in perihilar cholangiocarcinoma. Cancers (Basel). 2021;13(21):5278.

doi: 10.3390/cancers13215278

Mizuno T, Ebata T, Yokoyama Y, Igami T, Yamaguchi J, Onoe S, et al. Combined vascular resection for locally advanced perihilar cholangiocarcinoma. Ann Surg. 2022;275(2):382–90.

doi: 10.1097/SLA.0000000000004322

Oh DY, Lee KH, Lee DW, Yoon J, Kim TY, Bang JH, et al. Gemcitabine and cisplatin plus durvalumab with or without tremelimumab in chemotherapy-naive patients with advanced biliary tract cancer: an open-label, single-centre, phase 2 study. Lancet Gastroenterol Hepatol. 2022;7(6):522–32.

doi: 10.1016/S2468-1253(22)00043-7