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Perez M, Palnaes Hansen C, Burdio F, Sanchez-Velázquez P, Giuliani A, Lancellotti F, de Liguori-Carino N, Malleo G, Marchegiani G, Podda M, Pisanu A, De Luca GM, Anselmo A, Siragusa L, Kobbelgaard Burgdorf S, Tschuor C, Cacciaguerra AB, Koh YX, Masuda Y, Hao Xuan MY, Seeger N, Breitenstein S, Grochola FL, Di Martino M, Secanella L, Busquets J, Dorcaratto D, Mora-Oliver I, Ingallinella S, Salvia R, Abu Hilal M, Aldrighetti L, Ielpo B. A machine learning predictive model for recurrence of resected distal cholangiocarcinoma: Development and validation of predictive model using artificial intelligence. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108375. [PMID: 38795677 DOI: 10.1016/j.ejso.2024.108375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Distal Cholangiocarcinoma (dCCA) represents a challenge in hepatobiliary oncology, that requires nuanced post-resection prognostic modeling. Conventional staging criteria may oversimplify dCCA complexities, prompting the exploration of novel prognostic factors and methodologies, including machine learning algorithms. This study aims to develop a machine learning predictive model for recurrence after resected dCCA. MATERIAL AND METHODS This retrospective multicentric observational study included patients with dCCA from 13 international centers who underwent curative pancreaticoduodenectomy (PD). A LASSO-regularized Cox regression model was used to feature selection, examine the path of the coefficient and create a model to predict recurrence. Internal and external validation and model performance were assessed using the C-index score. Additionally, a web application was developed to enhance the clinical use of the algorithm. RESULTS Among 654 patients, LNR (Lymph Node Ratio) 15, neural invasion, N stage, surgical radicality, and differentiation grade emerged as significant predictors of disease-free survival (DFS). The model showed the best discrimination capacity with a C-index value of 0.8 (CI 95 %, 0.77%-0.86 %) and highlighted LNR15 as the most influential factor. Internal and external validations showed the model's robustness and discriminative ability with an Area Under the Curve of 92.4 % (95 % CI, 88.2%-94.4 %) and 91.5 % (95 % CI, 88.4%-93.5 %), respectively. The predictive model is available at https://imim.shinyapps.io/LassoCholangioca/. CONCLUSIONS This study pioneers the integration of machine learning into prognostic modeling for dCCA, yielding a robust predictive model for DFS following PD. The tool can provide information to both patients and healthcare providers, enhancing tailored treatments and follow-up.
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Affiliation(s)
- Marc Perez
- Hepato Pancreato Biliary Division, Hospital Del Mar, Universitat Pompeu Fabra, Barcelona, Spain.
| | | | - Fernando Burdio
- Hepato Pancreato Biliary Division, Hospital Del Mar, Universitat Pompeu Fabra, Barcelona, Spain.
| | | | - Antonio Giuliani
- Unit of General Surgery, San Giuseppe Moscati Hospital, Aversa, Italy.
| | - Francesco Lancellotti
- Department of Hepato-Pancreato-Biliary Surgery, Manchester Royal Infirmary, University of Manchester, Manchester, United Kingdom.
| | - Nicola de Liguori-Carino
- Department of Hepato-Pancreato-Biliary Surgery, Manchester Royal Infirmary, University of Manchester, Manchester, United Kingdom.
| | - Giuseppe Malleo
- Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy.
| | - Giovanni Marchegiani
- Hepato Biliary Pancreatic (HPB) and Liver Transplant Surgery, Department of Surgery, Oncology and Gastroenterology (DiSCOG), Padova University, Padova, Italy.
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy.
| | - Adolfo Pisanu
- Department of Surgical Science, University of Cagliari, Cagliari, Italy.
| | - Giuseppe Massimiliano De Luca
- University of Bari "A. Moro", Department of Biomedical Sciences and Human Oncology, Unit of Academic General Surgery " V. Bonomo", Bari, Italy.
| | - Alessandro Anselmo
- Department of Surgery, HPB and Transplant Surgery Unit, Policlinico Tor Vergata, Rome, Italy.
| | - Leandro Siragusa
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | | | - Christoph Tschuor
- Department of Surgery, Rigshospitalet, University of Copenhagen, Denmark.
| | - Andrea Benedetti Cacciaguerra
- HPB Surgery and Transplantation Unit, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Ancona, Italy.
| | - Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
| | - Yoshio Masuda
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
| | - Mark Yeo Hao Xuan
- HPB Unit, Department of Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
| | - Nico Seeger
- HPB Unit, Department of Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
| | - Stefan Breitenstein
- HPB Unit, Department of Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
| | - Filip Lukasz Grochola
- HPB Unit, Department of Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
| | - Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
| | | | | | - Dimitri Dorcaratto
- Department of General Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, University of Valencia, Spain.
| | - Isabel Mora-Oliver
- Department of General Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, University of Valencia, Spain.
| | | | - Roberto Salvia
- Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy.
| | | | | | - Benedetto Ielpo
- Hepato Pancreato Biliary Division, Hospital Del Mar, Universitat Pompeu Fabra, Barcelona, Spain.
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Labib PL, Russell TB, Denson JL, Puckett MA, Ausania F, Pando E, Roberts KJ, Kausar A, Mavroeidis VK, Bhogal RH, Marangoni G, Thomasset SC, Frampton AE, Spalding DR, Lykoudis P, Bellotti R, Alhaboob N, Srinivasan P, Bari H, Smith A, Dominguez-Rosado I, Croagh D, Thakkar RG, Gomez D, Silva MA, Lapolla P, Mingoli A, Davidson BR, Porcu A, Shah NS, Hamady ZZ, Al-Sarireh BA, Serrablo A, Aroori S. Patterns, timing and predictors of recurrence following pancreaticoduodenectomy for distal cholangiocarcinoma: An international multicentre retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108353. [PMID: 38701690 DOI: 10.1016/j.ejso.2024.108353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/21/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Patients undergoing pancreaticoduodenectomy for distal cholangiocarcinoma (dCCA) often develop cancer recurrence. Establishing timing, patterns and risk factors for recurrence may help inform surveillance protocol strategies or select patients who could benefit from additional systemic or locoregional therapies. This multicentre retrospective cohort study aimed to determine timing, patterns, and predictive factors of recurrence following pancreaticoduodenectomy for dCCA. MATERIALS AND METHODS Patients who underwent pancreaticoduodenectomy for dCCA between June 2012 and May 2015 with five years of follow-up were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on comorbidities, investigations, operation details, complications, histology, adjuvant and palliative therapies, recurrence-free and overall survival. Univariable tests and regression analyses investigated factors associated with recurrence. RESULTS In the cohort of 198 patients, 129 (65%) developed recurrence: 30 (15%) developed local-only recurrence, 44 (22%) developed distant-only recurrence and 55 (28%) developed mixed pattern recurrence. The most common recurrence sites were local (49%), liver (24%) and lung (11%). 94% of patients who developed recurrence did so within three years of surgery. Predictors of recurrence on univariable analysis were cancer stage, R1 resection, lymph node metastases, perineural invasion, microvascular invasion and lymphatic invasion. Predictors of recurrence on multivariable analysis were female sex, venous resection, advancing histological stage and lymphatic invasion. CONCLUSION Two thirds of patients have cancer recurrence following pancreaticoduodenectomy for dCCA, and most recur within three years of surgery. The commonest sites of recurrence are the pancreatic bed, liver and lung. Multiple histological features are associated with recurrence.
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Affiliation(s)
- Peter Lz Labib
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Thomas B Russell
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Jemimah L Denson
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Mark A Puckett
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | | | | | - Keith J Roberts
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ambareen Kausar
- East Lancashire Hospital NHS Trust, Blackburn, United Kingdom
| | - Vasileios K Mavroeidis
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ricky H Bhogal
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Gabriele Marangoni
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | - Adam E Frampton
- Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | | | - Pavlos Lykoudis
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | | | | | - Parthi Srinivasan
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Hassaan Bari
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Andrew Smith
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | | | - Rohan G Thakkar
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Dhanny Gomez
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Michael A Silva
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Andrea Mingoli
- Policlinico Umberto I Sapienza University of Rome, Rome, Italy
| | | | - Alberto Porcu
- Cliniche San Pietro, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Nehal S Shah
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Zaed Z Hamady
- University Hospital Southampton Foundation Trust, Southampton, United Kingdom
| | | | | | - Somaiah Aroori
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom; University of Plymouth, Plymouth, United Kingdom.
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Busquets J, Secanella L, Cifre P, Sorribas M, Serrano T, Martínez-Carnicero L, Leiva D, Laquente B, Salord S, Peláez N, Fabregat J. Prognostic risk factors in 113 patients undergoing cephalic duodenopancreatectomy for distal cholangiocarcinoma. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:448-456. [PMID: 37827384 DOI: 10.1016/j.gastrohep.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/25/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Distal cholangiocarcinoma is a malignant epithelial neoplasia that affects the extrahepatic bile ducts, below the cystic duct. No relevant relationship between perioperative factors and worse long-term outcome has been proved. OBJECTIVE To analyze the risk factors for mortality and long-term recurrence of distal cholangiocarcinoma in resected patients. MATERIALS AND METHODS A single-center prospective database of patients operated on for distal cholangiocarcinoma between 1990 and 2021 was analyzed in order to investigate mortality and recurrence factors. RESULTS One hundred and thirteen patients have undergone surgery, with mean actuarial survival of 100.2 (76-124) months after resection. The bivariate study did not show differences between patients depending on age or preoperative variables studied. When multivariate analysis was performed, the presence of affected adenopathy was a risk factor for long-term mortality. The presence of affected lymph nodes, tumor recurrence, and biliary fistula during the postoperative period implied worse actuarial survival when comparing the Kaplan-Meier curves. CONCLUSIONS The presence of affected lymph nodes influence the prognosis of the disease. The occurrence of biliary fistula during postoperative cholangiocarcinoma distal could aggravate long-term outcomes, a finding that should be reaffirmed in future studies.
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Affiliation(s)
- Juli Busquets
- Unitat de Cirurgia Hepatobiliopancreàtica, Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - Luís Secanella
- Unitat de Cirurgia Hepatobiliopancreàtica, Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; Departament d'Infermeria Fonamental i Medicoquirúrgica, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - Paula Cifre
- Unitat de Cirurgia Hepatobiliopancreàtica, Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, España
| | - María Sorribas
- Unitat de Cirurgia Hepatobiliopancreàtica, Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Teresa Serrano
- Servei de Anatomia Patològica, Hospital Universitari de Bellvitge, Barcelona, España
| | | | - David Leiva
- Servei de Radiodiagnòstic, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Berta Laquente
- Servei d'Oncologia Mèdica, Instituto Catalán de Oncología. Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Silvia Salord
- Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; Servei de Gastroenterologia, Hospital Universitari de Bellvitge, Barcelona, España
| | - Nuria Peláez
- Unitat de Cirurgia Hepatobiliopancreàtica, Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Juan Fabregat
- Unitat de Cirurgia Hepatobiliopancreàtica, Servei de Cirurgia General i Digestiva, Hospital Universitari de Bellvitge, Barcelona, España; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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Ielpo B, Alborino S, Melloul E, Salvatori F, Lai Q, Rossi M, Demartines N, Di Saverio S. Interventional treatment options for management of delayed arterial hemorrhage after major hepato-pancreatic-biliary surgery. Hepatobiliary Pancreat Dis Int 2023; 22:648-649. [PMID: 36882358 DOI: 10.1016/j.hbpd.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Benedetto Ielpo
- Unidad de Cirugía Hepatobiliopancreática, Hospital del Mar, Barcelona, Spain
| | - Salvatore Alborino
- Interventional Radiology Unit, Macerata Hospital, Macerata, AV4, ASUR Marche, Italy
| | - Emmanuel Melloul
- HBP and Liver Transplant Surgery Unit, Visceral Surgery Dept, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Fabio Salvatori
- Interventional Radiology Unit, Macerata Hospital, Macerata, AV4, ASUR Marche, Italy
| | - Quirino Lai
- HBP and Liver Transplant Surgery Unit, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy
| | - Massimo Rossi
- HBP and Liver Transplant Surgery Unit, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy
| | - Nicolas Demartines
- HBP and Liver Transplant Surgery Unit, Visceral Surgery Dept, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Salomone Di Saverio
- General Surgery Unit, San Benedetto del Tronto Hospital, San Benedetto del Tronto, AV5, ASUR Marche, Italy.
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Yoshii H, Izumi H, Fujino R, Kurata M, Inomoto C, Sugiyama T, Nakagohri T, Nomura E, Mukai M, Tajiri T. Subserosal Layer and/or Pancreatic Invasion Based on Anatomical Features as a Novel Prognostic Indicator in Patients with Distal Cholangiocarcinoma. Diagnostics (Basel) 2023; 13:3406. [PMID: 37998542 PMCID: PMC10670817 DOI: 10.3390/diagnostics13223406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
The American Joint Committee on Cancer (AJCC) 8th edition T-staging system for distal cholangiocarcinoma (DCC) proposes classification according to the depth of invasion (DOI); nevertheless, DOI measurement is complex and irreproducible. This study focused on the fibromuscular layer and evaluated whether the presence or absence of penetrating fibromuscular invasion of DCC contributes to recurrence and prognosis. In total, 55 patients pathologically diagnosed with DCC who underwent surgical resection from 2002 to 2022 were clinicopathologically examined. Subserosal layer and/or pancreatic (SS/Panc) invasion, defined as penetration of the fibromuscular layer and invasion of the subserosal layer or pancreas by the cancer, was assessed with other clinicopathological prognostic factors to investigate recurrence and prognostic factors. According to the AJCC 8th edition, there were 11 T1, 28 T2, and 16 T3 cases, with 44 (80%) cases of SS/Panc invasion. The DOI was not significantly different for both recurrence and prognostic factors. In the multivariate analysis, only SS/Panc was identified as an independent factor for prognosis (hazard ratio: 16.1; 95% confidence interval: 2.1-118.8, p = 0.006). In conclusion, while the determination of DOI in DCC does not accurately reflect recurrence and prognosis, the presence of SS/Panc invasion may contribute to the T-staging system.
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Affiliation(s)
- Hisamichi Yoshii
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Hideki Izumi
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Rika Fujino
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Makiko Kurata
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan (T.S.); (T.T.)
| | - Chie Inomoto
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan (T.S.); (T.T.)
| | - Tomoko Sugiyama
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan (T.S.); (T.T.)
| | - Toshio Nakagohri
- Department of Gastroenterological Surgery, Tokai University Hospital, Isehara 259-1193, Japan
| | - Eiji Nomura
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Masaya Mukai
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Takuma Tajiri
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan (T.S.); (T.T.)
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Mashiko T, Ogasawara T, Masuoka Y, Ei S, Takahashi S, Mori M, Koyanagi K, Yamamoto S, Nakagohri T. Indications for resection of recurrent lesions in patients with distal cholangiocarcinoma based on prognostic factors: a single-institute retrospective study and brief literature review. BMC Surg 2022; 22:423. [PMID: 36503431 PMCID: PMC9743743 DOI: 10.1186/s12893-022-01879-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of surgery for recurrent distal cholangiocarcinoma and determine surgical indications based on prognostic factors for the recurrence of distal cholangiocarcinoma. METHODS We analysed the outcomes of 101 patients who underwent surgical resection for distal cholangiocarcinoma between 2000 and 2018. The clinicopathological factors and prognosis of primary and recurrent distal cholangiocarcinoma were investigated. RESULTS Of the 101 patients with resected distal cholangiocarcinoma, 52 (51.5%) had relapsed. Seven (13.5%) and 45 patients (86.5%) underwent resection of recurrent lesions and palliative therapy, respectively. There were no major complications requiring therapeutic intervention after metastasectomy. The median overall survival in patients with and without surgery for recurrent lesions was 83.0 (0.0-185.6) and 34 months (19.0-49.0), respectively. Therefore, patients who had undergone surgery for recurrent lesions had a significantly better prognosis (p = 0.022). Multivariate analyses of recurrent distal cholangiocarcinoma revealed that recurrence within one year was an independent predictor of poor survival. Resection of recurrent lesions improved prognosis. CONCLUSIONS Radical resection in recurrent distal cholangiocarcinoma may improve the prognosis in selected patients. Although time to recurrence is considered an important factor, the small number of cases of recurrence and resection of recurrent lesions in this study makes it difficult to conclude which patients are best suited for resection of recurrent lesions. This issue requires clarification in a multicentre prospective study, considering patients' background, such as the recurrence site and number of metastases.
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Affiliation(s)
- Taro Mashiko
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Toshihito Ogasawara
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshihito Masuoka
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Shigenori Ei
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Shinichiro Takahashi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Seiichiro Yamamoto
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Toshio Nakagohri
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Li S, Zhang X, Lou C, Gu Y, Zhao J. Preoperative peripheral blood inflammatory markers especially the fibrinogen-to-lymphocyte ratio and novel FLR-N score predict the prognosis of patients with early-stage resectable extrahepatic cholangiocarcinoma. Front Oncol 2022; 12:1003845. [PMID: 36387142 PMCID: PMC9659886 DOI: 10.3389/fonc.2022.1003845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2023] Open
Abstract
Background Systemic inflammation is important in the development of extrahepatic cholangiocarcinoma (ECC). The aim of this study was to compare the prognostic power of preoperative peripheral blood inflammatory markers and the novel FLR-N score in patients with resectable ECC. Methods A total of 140 patients with resectable ECC and 140 healthy controls (HCs) were recruited for the study. The Mann−Whitney U test was used to evaluate the differences in inflammatory markers between groups. Kaplan−Meier and Cox regression analyses were used to evaluate the prognostic power of preoperative fibrinogen, albumin, prealbumin, bilirubin, neutrophils, lymphocytes, monocytes, platelets, fibrinogen-to-lymphocyte ratio (FLR), fibrinogen-to-albumin ratio (FAR), fibrinogen-to-prealbumin ratio (FPR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), FLR-neutrophil (FLR-N) score, and CA19-9 in patients with resectable ECC. Nomogram was developed based on the results of multivariate Cox analyses. Results Patients with resectable ECC had significantly higher levels of neutrophils, monocytes, fibrinogen, FLR, FAR, FPR, NLR, PLR, and MLR and lower levels of lymphocytes, albumin, and prealbumin than HCs (all P < 0.01). Albumin, prealbumin, and FPR had a good ability to distinguish between ECC patients with total bilirubin < 34 µmol/L and HCs (AUCs of 0.820, 0.827, and 0.836, respectively). Kaplan−Meier analysis showed that high neutrophil, fibrinogen, FLR, FAR, PLR, MLR, and FLR-N score values were associated with poor survival in patients with resectable ECC. Multivariate analyses indicated that neutrophils (P = 0.022), FLR (P = 0.040), FLR-N score (P < 0.0001), and positive lymph node metastasis (P = 0.016) were independent factors for overall survival (OS). Nomogram were developed to predict OS for patients with ECC. Conclusion The prognostic roles of inflammatory markers in patients with resectable ECC were different. The preoperative neutrophil count, FLR and FLR-N score could serve as noninvasive markers for predicting the prognosis of resectable ECC.
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Affiliation(s)
- Shijie Li
- Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xingli Zhang
- Biotherapy Center, Harbin Medical University Cancer Hospital, Harbin, China
| | - Changjie Lou
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Yuanlong Gu
- Biotherapy Center, Harbin Medical University Cancer Hospital, Harbin, China
- Department of Interventional Oncology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
- *Correspondence: Juan Zhao, ; Yuanlong Gu,
| | - Juan Zhao
- Biotherapy Center, Harbin Medical University Cancer Hospital, Harbin, China
- *Correspondence: Juan Zhao, ; Yuanlong Gu,
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Anatomical Resection Improved the Outcome of Intrahepatic Cholangiocarcinoma: A Propensity Score Matching Analysis of a Retrospective Cohort. JOURNAL OF ONCOLOGY 2022; 2022:4446243. [PMID: 36330355 PMCID: PMC9626204 DOI: 10.1155/2022/4446243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignancy after hepatocellular carcinoma (HCC), with a dismal prognosis and high heterogeneity. The oncological advantages of anatomical resection (AR) and nonanatomical resection (NAR) in HCC have been studied, but surgical strategies for ICC remain controversial with insufficient investigations. Materials and Methods From Jan 2013 to Dec 2016, 3880 consecutive patients were retrospectively reviewed from a single center. Patients with ICC undergoing AR or NAR have been enrolled according to inclusion and exclusion criteria. Propensity score matching (PSM) analysis was performed between two groups with a 1 : 1 ratio. The primary endpoint was overall survival (OS), and the secondary endpoints included disease-free survival (DFS), intraoperative patterns, postoperative morbidity, mortality, complications and recurrence. A prognostic nomogram was developed by a multivariate Cox proportion hazard model. Results After PSM, 99 paired cases were selected from 276 patients enrolled in this study. Patients in the AR group achieved better 1-, 3-, and 5-year OS (70%, 46%, and 34%, respectively) and DFS (61%, 21%, and 10%, respectively) than patients in the NAR group with statistical significance after PSM analysis. The postoperative complications and recurrence patterns were comparable between the two groups. Multivariate analysis identified NAR, tumor size >5 cm, multiple tumors, and poor differentiation as independent risk factors for OS (p < 0.05). Selected patients can benefit most from AR, according to subgroup analysis. A prognostic nomogram based on six independent risk factors for OS and factors with clinical significance was constructed to predict OS in ICC patients. Conclusion AR improved the long-term survival of ICC with comparable postoperative complications and similar recurrence patterns. AR is suggested in ICC patients with sufficient remnant liver volume. In addition to surgery strategy, malignant characteristics of tumors are risk factors for ICC prognosis.
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Zhang B, Yao W. Prognostic role of the systemic immune-inflammation index in biliary tract cancers: a meta-analysis of 3,515 patients. World J Surg Oncol 2022; 20:320. [PMID: 36171621 PMCID: PMC9519406 DOI: 10.1186/s12957-022-02783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background The systemic immune-inflammation index (SII) is an inflammatory parameter calculated as platelet count × neutrophil count/lymphocyte count in the peripheral blood. In recent years, the prognostic role of the SII in patients with biliary tract cancer (BTC) has been gradually investigated. However, the results were controversial. This meta-analysis aimed to illustrate the prognostic value of the SII in BTC. Methods The electronic databases of PubMed, the Web of Science, Embase, and the Cochrane Library were thoroughly retrieved up to April 15, 2022. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were used to evaluate the prognostic value of the SII for clinical outcomes. The association between the SII and overall survival (OS) and recurrence-free survival (RFS)/progression-free survival (PFS) was evaluated. Results Thirteen studies involving 3515 patients were included in this meta-analysis. The pooled results indicated that an elevated SII was significantly associated with poor OS (HR, 1.77; 95% CI, 1.47–2.14; p<0.001) and RFS/PFS (HR, 1.66; 95% CI, 1.38–1.99; p<0.001) in patients with BTC. Subgroup analysis stratified by country, sample size, and cutoff value showed similar results. The sensitivity analysis and publication bias test confirmed the reliability of our results. Conclusions An elevated pretreatment SII was significantly associated with worse OS and RFS/PFS in patients with BTC. Our results suggest that the SII is a valuable and cost-effective prognostic parameter for the treatment of patients with BTC. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02783-z.
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Affiliation(s)
- Buwen Zhang
- Department of Oncology, Changxing People's Hospital, Huzhou, 313100, Zhejiang, China
| | - Weiyun Yao
- Department of Hepatobiliary Surgery, Changxing People's Hospital, Huzhou, 313100, Zhejiang, China.
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