Neoadjuvant chemotherapy followed by curative-intent surgery for perihilar cholangiocarcinoma based on its anatomical resectability classification and lymph node status
Naohisa Kuriyama,
Masanobu Usui,
Kazuaki Gyoten,
Aoi Hayasaki,
Takehiro Fujii,
Yusuke Iizawa,
Hiroyuki Kato,
Yasuhiro Murata,
Akihiro Tanemura,
Masashi Kishiwada,
Hiroyuki Sakurai,
Shugo Mizuno,
Shuji Isaji
Affiliations
Naohisa Kuriyama
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Masanobu Usui
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Kazuaki Gyoten
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Aoi Hayasaki
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Takehiro Fujii
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Yusuke Iizawa
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Hiroyuki Kato
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Yasuhiro Murata
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Akihiro Tanemura
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Masashi Kishiwada
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Hiroyuki Sakurai
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Shugo Mizuno
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Shuji Isaji
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine
Abstract Background The prognosis of patients with perihilar cholangiocarcinoma have been unsatisfactory. We established new anatomical resectability classification for patients with localized perihilar cholangiocarcinoma and performed neoadjuvant chemotherapy followed by curative-intent surgery based on its resectability classification and lymph node status to improve prognosis. This study aimed to clarify the long-term outcomes and validation of our strategy. Methods Between September 2010 and August 2018, 72 consecutive patients with perihilar cholangiocarcinoma were classified into three groups: Resectable (R = 29), Borderline resectable (BR = 23), and Locally advanced (LA = 20), based on the two factors of tumor vascular and biliary extension. R with clinically lymph node metastasis, BR, and LA patients received neoadjuvant chemotherapy using gemcitabine plus S-1. Results Forty-seven patients (65.3%) received neoadjuvant chemotherapy: R in 8, BR in 21, and 18 in LA, respectively. Fifty-nine patients (68.1%) underwent curative-intent surgery: R in 26, BR in 17, and LA in 6. Five-year disease-specific survival was 31.5% (median survival time: 33.0 months): 50.3% (not reached) in R, 30.0% (31.4 months) in BR, and 16.5% (22.5 months) in LA, which were relatively stratified. Among 49 patients with resection, disease-specific survival was 43.8% (57.0 months): 57.6% (not reached) in R, 41.0% (52.4 months) in BR, and 0% (49.4 months) in LA, which were significantly good prognosis compared to 23 patients without resection (17.2 months). Multivariate analysis identified preoperative high carcinoembryonic antigen levels (more than 8.5 ng/ml) and pT4 as independent poor prognostic factor of patients with resection. Conclusion Neoadjuvant chemotherapy based on resectability classification and lymph node status was feasible, and was considered efficacious in selected patients.
