Adjuvant chemoradiotherapy for positive hepatic ductal margin on cholangiocarcinoma

Abstract

Abstract Aim This study evaluated the effects of postoperative adjuvant chemoradiotherapy (A‐CRT) for positive hepatic ductal margin (HM+) in extrahepatic cholangiocarcinoma (EHCC). Methods Patients with EHCC who underwent surgical resection between 2002 and 2014 were included in this retrospective study. For patients with HM+, A‐CRT was conducted. The clinical effect of A‐CRT for HM+ on the survival and recurrence and prognostic factors of EHCC was reviewed. Results Among 340 patients, the hepatic ductal margin was negative in 296 and positive in 44. Of the 44 patients with HM+, 22 received postoperative A‐CRT, and 22 did not. Hepatic stump recurrence occurred in 19 patients. The incidence was significantly higher in patients with HM+ (20%, 9/44) than in those with negative hepatic ductal margin (HM−) (3%, 10/296) (P < .001). Among the patients with HM+, the incidence was almost identical between the patients with and without A‐CRT: 23% (5/22) in HM+/CRT− and 18% (4/22) in HM+/CRT+ patients (P = .999). The median survival time was 49 months in HM−, 43 months in HM+/CRT−, and 49 months in HM+/CRT+ patients. The differences were not significant among the groups. A multivariate analysis revealed CA 19‐9 ≥ 300 U/mL, combined vascular resection, histologic grade G2/G3, and lymph node metastasis to be significant prognostic factors. However, the performance of postoperative A‐CRT did not contribute to prolonging survival. Conclusion A‐CRT for HM+ in patients with EHCC did not affect the survival or stump recurrence.

Keywords

• adjuvant chemoradiotherapy
• cholangiocarcinoma
• positive ductal margin
• stump recurrence
• survival