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Nitta N, Ohgi K, Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, Otsuka S, Sasaki K, Uesaka K. Prognostic Impact of Paraaortic Lymph Node Metastasis in Extrahepatic Cholangiocarcinoma. World J Surg 2020; 45:581-589. [PMID: 33079246 DOI: 10.1007/s00268-020-05834-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical resection in patients with extrahepatic cholangiocarcinoma (EHCC) with paraaortic lymph node metastasis (PALNM) remains controversial. The objective of this study was to investigate the prognostic impact of PALNM in resected EHCC. METHODS The present retrospective study included 410 patients, including 16 patients with PALNM, who underwent surgical resection of EHCC between September 2002 and December 2018. These were compared to 9 patients in whom EHCC was not resected due to PALNM. The clinicopathological features and survival outcomes were investigated to identify the prognostic factors in resected EHCC. RESULTS The overall survival in the resected patients with PALNM was significantly better than that in unresected patients (median survival time [MST] 33.7 vs. 16.7 months, p=0.009) and was not significantly worse than that of patients with regional lymph node metastasis (LNM) (MST 33.7 vs 36.0 months, p=0.278). The multivariate analysis identified age > 70 years, male sex, tumor location (perihilar), residual tumor status, histological grade, microscopic venous invasion, and regional LNM as independent prognostic factors. CONCLUSIONS There was no significant difference in survival between the resected patients with PALNM and patients with regional LNM, and PALNM was not a significant prognostic factor in the multivariate analysis. Surgical resection may be considered an acceptable approach for EHCC with PALNM in selected patients.
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Affiliation(s)
- Nobuhito Nitta
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto- Nagaizumi, Shizuoka, 4118777, Japan
| | - Katsuhisa Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto- Nagaizumi, Shizuoka, 4118777, Japan.
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto- Nagaizumi, Shizuoka, 4118777, Japan
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto- Nagaizumi, Shizuoka, 4118777, Japan
| | - Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto- Nagaizumi, Shizuoka, 4118777, Japan
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto- Nagaizumi, Shizuoka, 4118777, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto- Nagaizumi, Shizuoka, 4118777, Japan
| | - Shimpei Otsuka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto- Nagaizumi, Shizuoka, 4118777, Japan
| | - Keiko Sasaki
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto- Nagaizumi, Shizuoka, 4118777, Japan
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Jeong S, Tong Y, Sha M, Gu J, Xia Q. Hepatitis B virus-associated intrahepatic cholangiocarcinoma: a malignancy of distinctive characteristics between hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Oncotarget 2017; 8:17292-17300. [PMID: 28030846 PMCID: PMC5370041 DOI: 10.18632/oncotarget.14079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/13/2016] [Indexed: 12/15/2022] Open
Abstract
It has been a decade since hepatitis B virus infection was identified as an etiological factor for the development of intrahepatic cholangiocarcinoma (ICC). In recent years, several studies have elucidated the critical impact of hepatitis B virus in ICC that significantly influenced the clinicopathological characteristics of ICC patients with intrahepatic cholangiocarcinoma. Distinctive features of patients with hepatitis B virus-associated ICC included younger age, preponderance of male patients, frequent elevation of alpha-fetoprotein, and infrequent lymph node metastasis. Furthermore, several studies indicated that the presence of hepatitis B virus is a favorable prognostic factor in terms of overall survival and relapse-free survival. However, there are also a few studies demonstrating that hepatitis B virus negatively influenced or showed no significant association with survival outcomes of patients with ICC. At present, there are no consensus on diagnostic procedures and treatments for such population. Therefore, we elucidated current knowledge and recent identifications of HBV-associated ICC to clarify the impact of chronic HBV infection on patients with ICC and to precisely conduct diagnostic procedures and curative treatments for HBV-associated ICC.
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Affiliation(s)
- Seogsong Jeong
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ying Tong
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Meng Sha
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jinyang Gu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Prognostic Impact of Cirrhosis in Patients with Intrahepatic Cholangiocarcinoma following Hepatic Resection. Can J Gastroenterol Hepatol 2017; 2017:6543423. [PMID: 29259967 PMCID: PMC5702404 DOI: 10.1155/2017/6543423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/21/2017] [Accepted: 05/30/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prognostic impact of cirrhosis in patients with intrahepatic cholangiocarcinoma (ICC) upon hepatic resection remains unclear due to lack of studies in the literature. METHODS A total of 106 resected patients with ICC were reviewed, including 25 patients (23.6%) with cirrhosis and 81 noncirrhotic patients (76.4%). Subgroups of cirrhotic patients with and without hepatitis B virus (HBV) infection were studied. RESULTS The impact of cirrhosis on the overall survival (OS) (hazard ratio [HR], 0.901; 95% confidence interval [CI], 0.510 to 1.592; P = 0.720) and the relapse-free survival (RFS) (HR, 0.889; 95% CI, 0.509 to 1.552; P = 0.678) revealed no statistical significance. Furthermore, HBV-associated cirrhotic patients and the other cirrhotic patients demonstrated no statistical difference on survival outcomes (1 yr OS, 60.0% versus 70.0%; 5 yr OS, 10.0% versus 0%; P = 0.744; 1 yr RFS, 53.3% versus 30.0%; 5 yr RFS, 10.0% versus 0%; P = 0.279). In patients with cirrhosis, tumor size larger than 5 cm was found to be the foremost factor that was independently associated with poor prognosis. CONCLUSION The presence of liver cirrhosis did not significantly affect prognosis of patients with ICC after resection. Downstaging modality may be in need for patients with ICC underlying cirrhosis, which remains to be validated in future studies.
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