Cancer Management and Research (Dec 2020)

Independent Risk Factors of Early Recurrence After Curative Resection for Perihilar Cholangiocarcinoma: Adjuvant Chemotherapy May Be Beneficial in Early Recurrence Subgroup

  • Zhao J,
  • Zhang W,
  • Zhang J,
  • Chen YT,
  • Ma WJ,
  • Liu SY,
  • Li FY,
  • Song B

Journal volume & issue
Vol. Volume 12
pp. 13111 – 13123

Abstract

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Jian Zhao,1,2,* Wei Zhang,1,2,* Jun Zhang,1 Yun-Tian Chen,1 Wen-Jie Ma,3 Si-Yun Liu,4 Fu-Yu Li,3,* Bin Song1,* 1Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China; 2Department of Radiology, Armed Police Force Hospital of Sichuan, Leshan 614000, Sichuan, People’s Republic of China; 3Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China; 4GE Healthcare (China), Beijing 100176, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bin Song Email [email protected]: In current clinical practice, early recurrence (ER) is not commonly discussed in perihilar cholangiocarcinoma (pCCA), and its risk factors for this disease have not been well clarified. We carried out this study to analyze the risk factors contributing to ER and explored the prognostic factors after curative resection for pCCA.Patients and Methods: A total of 335 consecutive pCCA patients were retrospectively analyzed. Risk factors contributing to ER were evaluated using univariate and multivariate logistic regression analyses. Prognostic factors of the ER group were determined by univariate and multivariate Cox regression models. The overall survival (OS) rate was calculated using the Kaplan–Meier method. The Log rank test was used for OS comparison.Results: Of the 335 cases, 258 patients (77.0%) developed tumor recurrence, 136 patients (40.6%) developed ER, and 122 patients (36.4%) developed late recurrence (LR) postoperatively. The median OS of the ER and LR groups was 15 months and 36 months, respectively (P< 0.001). The multivariate analysis revealed that poor pathological differentiation (P=0.006; moderate vs well, odds ratio [OR]=2.162, 95% confidence interval [CI] 0.753– 6.208, P=0.152; poor vs well, OR=4.839, 95% CI 1.544– 15.170, P=0.007), perineural invasion (OR=4.797, 95% CI 1.586– 14.510, P=0.005), and high levels of preoperative carbohydrate antigen 19– 9 (CA19-9) (OR=2.205, 95% CI 1.208– 4.026, P=0.010) were independent risk factors of developing ER after resection. Adjuvant chemotherapy (HR=0.383, 95% CI 0.154– 0.953, P=0.039) remained as the independent protective factor of OS in patients with ER.Conclusion: It is recommended that patients with poorly differentiated tumors, presence of perineural invasion, and high levels of preoperative CA19-9 receive closer follow-up and adjuvant chemotherapy following surgery.Keywords: perihilar cholangiocarcinoma, adjuvant chemotherapy, overall survival, curative-intent resection, early recurrence

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