|
1
|
Franssen S, Soares KC, Jolissaint JS, Tsilimigras DI, Buettner S, Alexandrescu S, Marques H, Lamelas J, Aldrighetti L, Gamblin TC, Maithel SK, Pulitano C, Margonis GA, Weiss MJ, Bauer TW, Shen F, Poultsides GA, Marsh JW, Cercek A, Kemeny N, Kingham TP, D’Angelica M, Pawlik TM, Jarnagin WR, Koerkamp BG. Comparison of Hepatic Arterial Infusion Pump Chemotherapy vs Resection for Patients With Multifocal Intrahepatic Cholangiocarcinoma. JAMA Surg 2022; 157:590-596. [PMID: 35544131 PMCID: PMC9096688 DOI: 10.1001/jamasurg.2022.1298] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/09/2022] [Indexed: 12/14/2022]
Abstract
Importance Intrahepatic cholangiocarcinoma (iCCA) is often multifocal (ie, satellites or intrahepatic metastases) at presentation. Objective To compare the overall survival (OS) of patients with multifocal iCCA after hepatic arterial infusion pump (HAIP) floxuridine chemotherapy vs resection. Design, Setting, and Participants In this cohort study, patients with histologically confirmed, multifocal iCCA were eligible. The HAIP group consisted of consecutive patients from a single center who underwent HAIP floxuridine chemotherapy for unresectable multifocal iCCA between January 1, 2001, and December 31, 2018. The resection group consisted of consecutive patients from 12 centers who underwent a curative-intent resection for multifocal iCCA between January 1, 1990, and December 31, 2017. Resectable metastatic disease to regional lymph nodes and previous systemic therapy were permitted. Patients with distant metastatic disease (ie, stage IV), those who underwent resection before starting HAIP floxuridine chemotherapy, and those who received a liver transplant were excluded. Data were analyzed on September 1, 2021. Main Outcomes and Measures Overall survival in the 2 treatment groups was compared using the Kaplan-Meier method and log-rank test. Results A total of 319 patients with multifocal iCCA were included: 141 in the HAIP group (median [IQR] age, 62 [53-70] years; 79 [56.0%] women) and 178 in the resection group (median [IQR] age, 60 [50-69] years; 91 [51.1%] men). The HAIP group was characterized by a higher percentage of bilobar disease (88.0% [n = 124] vs 34.3% [n = 61]), larger tumors (median, 8.4 cm vs 7.0 cm), and a higher proportion of patients with 4 or more lesions (66.7% [94] vs 24.2% [43]). Postoperative mortality after 30 days was 0.8% (95% CI, 0.0%-2.1%) in the HAIP group vs 6.2% (95% CI, 2.3%-9.7%) in the resection group (P = .01). The median OS for HAIP was 20.3 months vs 18.9 months for resection (P = .32). Five-year OS in patients with 2 or 3 lesions was 23.7% (95% CI, 12.3%-45.7%) in the HAIP group vs 25.7% (95% CI, 17.9%-37.0%) in the resection group. Five-year OS in patients with 4 or more lesions was 5.0% (95% CI, 1.7%-14.3%) in the HAIP group vs 6.8% (95% CI, 1.8%-25.3%) in the resection group. After adjustment for tumor diameter, number of tumors, and lymph node metastases, the hazard ratio of HAIP vs resection was 0.75 (95% CI, 0.55-1.03; P = .07). Conclusions and Relevance This cohort study found that patients with multifocal iCCA had similar OS after HAIP floxuridine chemotherapy vs resection. Resection of multifocal intrahepatic cholangiocarcinoma needs to be considered carefully given the complication rate of major liver resection; HAIP floxuridine chemotherapy may be an effective alternative option.
Collapse
Affiliation(s)
- Stijn Franssen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Kevin C. Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Stefan Buettner
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Hugo Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Jorge Lamelas
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | | | | | - Shishir K. Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Carlo Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Georgios A. Margonis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J. Weiss
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Todd W. Bauer
- Department of Surgery, University of Virginia, Charlottesville
| | - Feng Shen
- Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | | | - James Wallis Marsh
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael D’Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - William R. Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| |
Collapse
|
|
2
|
Bednarsch J, Tan X, Czigany Z, Liu D, Lang SA, Sivakumar S, Kather JN, Appinger S, Rosin M, Boroojerdi S, Dahl E, Gaisa NT, den Dulk M, Coolsen M, Ulmer TF, Neumann UP, Heij LR. The Presence of Small Nerve Fibers in the Tumor Microenvironment as Predictive Biomarker of Oncological Outcome Following Partial Hepatectomy for Intrahepatic Cholangiocarcinoma. Cancers (Basel) 2021; 13:cancers13153661. [PMID: 34359564 PMCID: PMC8345152 DOI: 10.3390/cancers13153661] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Nerve fibers in the microenvironment of malignant tumors have been shown to be an important prognostic factor for long-term survival in various cancer types; however, their role in intrahepatic cholangiocarcinoma remains to be determined. Therefore, the impact of nerve fibers on long-term survival was investigated in a large European cohort of patients with intrahepatic cholangiocarcinoma who were treated by curative-intent surgical resection. By univariate and multivariate statistics, the absence of nerve fibers was determined to be an independent predictor of impaired long-term survival. A group comparison between patients with and without nerve fibers showed a statically significant difference with a cancer-specific 5-year-survival of 47% in patients with nerve fibers compared to 21% in patients without nerve fibers. Thus, the presence of nerve fibers in the microenvironment of intrahepatic cholangiocarcinoma is revealed as a novel and important prognostic biomarker in these patients. Abstract The oncological role of the density of nerve fibers (NFs) in the tumor microenvironment (TME) in intrahepatic cholangiocarcinoma (iCCA) remains to be determined. Therefore, data of 95 iCCA patients who underwent hepatectomy between 2010 and 2019 was analyzed regarding NFs and long-term outcome. Extensive group comparisons were carried out and the association of cancer-specific survival (CSS) and recurrence-free survival (RFS) with NFs were assessed using Cox regression models. Patients with iCCA and NFs showed a median CSS of 51 months (5-year-CSS = 47%) compared to 27 months (5-year-CSS = 21%) in patients without NFs (p = 0.043 log rank). Further, NFs (hazard ratio (HR) = 0.39, p = 0.002) and N-category (HR = 2.36, p = 0.010) were identified as independent predictors of CSS. Patients with NFs and without nodal metastases displayed a mean CSS of 89 months (5-year-CSS = 62%), while patients without NFs or with nodal metastases but not both showed a median CCS of 27 months (5-year-CSS = 25%) and patients with both positive lymph nodes and without NFs showed a median CCS of 10 months (5-year-CSS = 0%, p = 0.001 log rank). NFs in the TME are, therefore, a novel and important prognostic biomarker in iCCA patients. NFs alone and in combination with nodal status is suitable to identify iCCA patients at risk of poor oncological outcomes following curative-intent surgery.
Collapse
Affiliation(s)
- Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
| | - Xiuxiang Tan
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
| | - Dong Liu
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
| | - Sven Arke Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
| | - Shivan Sivakumar
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK;
- Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, UK
| | - Jakob Nikolas Kather
- Department of Medicine III, University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Simone Appinger
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
| | - Mika Rosin
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
| | - Shiva Boroojerdi
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
| | - Edgar Dahl
- Institute of Pathology, University Hospital RWTH Aachen, 52074 Aachen, Germany; (E.D.); (N.T.G.)
| | - Nadine Therese Gaisa
- Institute of Pathology, University Hospital RWTH Aachen, 52074 Aachen, Germany; (E.D.); (N.T.G.)
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Center (MUMC), 6229 HX Maastricht, The Netherlands; (M.d.D.); (M.C.)
| | - Mariëlle Coolsen
- Department of Surgery, Maastricht University Medical Center (MUMC), 6229 HX Maastricht, The Netherlands; (M.d.D.); (M.C.)
| | - Tom Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
- Department of Surgery, Maastricht University Medical Center (MUMC), 6229 HX Maastricht, The Netherlands; (M.d.D.); (M.C.)
| | - Lara Rosaline Heij
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (X.T.); (Z.C.); (D.L.); (S.A.L.); (S.A.); (M.R.); (S.B.); (T.F.U.); (U.P.N.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6211 LK Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center (MUMC), 6229 HX Maastricht, The Netherlands; (M.d.D.); (M.C.)
- Correspondence:
| |
Collapse
|
|
3
|
Bednarsch J, Czigany Z, Heij LR, Liu D, den Dulk M, Wiltberger G, Bruners P, Ulmer TF, Neumann UP, Lang SA. Compelling Long-Term Results for Liver Resection in Early Cholangiocarcinoma. J Clin Med 2021; 10:jcm10132959. [PMID: 34209368 PMCID: PMC8268137 DOI: 10.3390/jcm10132959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 12/17/2022] Open
Abstract
Surgery for intrahepatic cholangiocarcinoma (iCCA) is associated with a high rate of recurrence even after complete resection. To achieve acceptable results, preoperative patient selection is crucial. Hence, we aimed to identify preoperative characteristics with prognostic value focusing on certain radiological features. Patients who underwent hepatectomy for iCCA between 2010 and 2020 at University Hospital, RWTH Aachen were included. Kaplan–Meier and Cox regressions were applied for survival analysis and associations of overall survival (OS) and recurrence-free survival (RFS) with clinical/radiological characteristics, respectively. Based on radiological features patients were stratified into three groups: single nodule ≤ 3 cm, single nodule > 3 cm, and ≥2 nodules. Analysis of 139 patients revealed a mean OS of 142 months for those with a single nodule ≤3 cm, median OS of 28 months with a single nodule >3 cm, and 19 months with ≥2 nodules, respectively. Multivariable analyses based on preoperative characteristics showed the radiological stratification to be independently associated with OS (HR (hazard ratio) = 4.25 (1 nodule, >3 cm), HR = 5.97 (≥2 nodules), p = 0.011), RFS (HR = 4.18 (1 nodule, >3 cm), and HR = 11.07 (≥2 nodules), p = 0.001). In conclusion, patients with single iCCA ≤3 cm show compelling OS and RFS. Basic radiological features (e.g., nodule size, number) are prognostic for patients undergoing surgery and useful in preoperative patient selection.
Collapse
Affiliation(s)
- Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (Z.C.); (L.R.H.); (D.L.); (M.d.D.); (G.W.); (T.F.U.); (U.P.N.)
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (Z.C.); (L.R.H.); (D.L.); (M.d.D.); (G.W.); (T.F.U.); (U.P.N.)
| | - Lara R. Heij
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (Z.C.); (L.R.H.); (D.L.); (M.d.D.); (G.W.); (T.F.U.); (U.P.N.)
- Institute of Pathology, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Dong Liu
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (Z.C.); (L.R.H.); (D.L.); (M.d.D.); (G.W.); (T.F.U.); (U.P.N.)
| | - Marcel den Dulk
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (Z.C.); (L.R.H.); (D.L.); (M.d.D.); (G.W.); (T.F.U.); (U.P.N.)
- Department of Surgery, Maastricht University Medical Center (MUMC), 6229 Maastricht, The Netherlands
| | - Georg Wiltberger
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (Z.C.); (L.R.H.); (D.L.); (M.d.D.); (G.W.); (T.F.U.); (U.P.N.)
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Tom Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (Z.C.); (L.R.H.); (D.L.); (M.d.D.); (G.W.); (T.F.U.); (U.P.N.)
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (Z.C.); (L.R.H.); (D.L.); (M.d.D.); (G.W.); (T.F.U.); (U.P.N.)
- Department of Surgery, Maastricht University Medical Center (MUMC), 6229 Maastricht, The Netherlands
| | - Sven Arke Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.B.); (Z.C.); (L.R.H.); (D.L.); (M.d.D.); (G.W.); (T.F.U.); (U.P.N.)
- Correspondence: ; Tel.: +49-241-80-89501
| |
Collapse
|