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Zhao J, Zhang W, Zhang J, Ma WJ, Liu SY, Li FY, Song B. External validation study of the 8 th edition of the American Joint Committee on Cancer staging system for perihilar cholangiocarcinoma: a single-center experience in China and proposal for simplification. J Gastrointest Oncol 2021; 12:806-818. [PMID: 34012668 DOI: 10.21037/jgo-20-348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Several changes have been made to the primary tumor (T) and lymph node (N) categories in the new 8th edition of the American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA). This study was conducted to validate the 8th edition of the AJCC staging system for pCCA in China. Methods A total of 335 patients who underwent curative-intent resection for pCCA between January 2010 and December 2018 were retrospectively enrolled. The overall survival (OS) of groups of patients was calculated using the Kaplan-Meier method. The log-rank test was used to compare OS between groups. The concordance index (C-index), Akaike information criteria (AIC), and time-dependent area under receiver operating characteristic (ROC) curve (AUC) were computed to evaluate the discriminatory power of the 8th and 7th editions of the AJCC staging system. Results The T category changed in 25 (7.5%) patients, the N category changed in 39 (11.6%) patients, and the tumor-node-metastasis (TNM) stage changed in 157 (46.9%) patients when the 8th and 7th editions were compared. No statistically significant difference in survival was observed between T2aN0M0 and T2bN0M0. The C-index of the 8th edition was 0.609 [95% confidence interval (CI): 0.568-0.650], which was slightly higher than that of the 7th edition (C-index, 0.599, 95% CI: 0.558-0.640). The time-dependent AUC value also corroborated that the 8th edition had a better performance than the 7th edition. Conclusions The 8th edition of the AJCC staging system for pCCA showed a better ability than the 7th edition to discriminate patient survival. However, further simplification of the 8th edition is still needed.
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Affiliation(s)
- Jian Zhao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, Armed Police Force Hospital of Sichuan, Leshan, China
| | - Wei Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, Armed Police Force Hospital of Sichuan, Leshan, China
| | - Jun Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | | | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Yu Z, Zhu J, Jiang H, He C, Xiao Z, Wang J, Xu J. Surgical Resection and Prognostic Analysis of 142 Cases of Hilar Cholangiocarcinoma. Indian J Surg 2018; 80:309-317. [PMID: 32288384 PMCID: PMC7102051 DOI: 10.1007/s12262-016-1581-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/23/2016] [Indexed: 12/12/2022] Open
Abstract
Surgical resection for hilar cholangiocarcinoma is the only curative option, but low resectability rate and poor survival outcomes remain a challenge. This study was to assess the surgical resection for hilar cholangiocarcinoma and analyze the prognostic factors influencing postoperative survival. One hundred forty-two patients with hilar cholangiocarcinoma who underwent surgical resection between January 2006 and December 2014 were analyzed retrospectively based on clinicopathological and demographic data. Univariate and multivariate analysis against outcome were employed to identify potential factors affecting prognosis. Ninety-five patients were performed with R0 resection with median survival time of 22 months; whereas, 47 patients underwent non-R0 resection (R1 = 20, R2 = 27) with that of 10 months. Of these 95 patients, 19 underwent concomitant with vascular resection and reconstruction and 2 patients underwent pancreaticoduodenectomy. 64.8% patients (n = 92) underwent combined with hepatectomy. The one-year, three-year, and five-year survival rates after R0 resection were 76.3, 27.8, 11.3%, respectively, which was significantly better than that after non-curative resection (P = 0.000). Multivariate analysis revealed that non-curative resection (RR: 2.414, 95% CI 1.586–3.676, P = 0.000), pathological differentiation (P = 0.015) and preoperative serum total bilirubin above 10 mg/dL (RR: 1.844, 95% CI 1.235–2.752, P = 0.003) were independent prognostic factors. Aggressive curative resection remains to be the optimal option for hilar cholangiocarcinoma. Non-curative resection, pathological differentiation, and preoperative serum total bilirubin above 10 mg/ dL were associated with dismal prognosis.
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Affiliation(s)
- Zhimin Yu
- Guandong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, #33 Yingfeng Road, Guangzhou, 510120 People's Republic of China
| | - Jie Zhu
- Guandong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, #33 Yingfeng Road, Guangzhou, 510120 People's Republic of China
| | - Hai Jiang
- Guandong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, #33 Yingfeng Road, Guangzhou, 510120 People's Republic of China
| | - Chuanchao He
- Guandong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, #33 Yingfeng Road, Guangzhou, 510120 People's Republic of China
| | - Zhiyu Xiao
- Guandong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, #33 Yingfeng Road, Guangzhou, 510120 People's Republic of China
| | - Jie Wang
- Guandong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, #33 Yingfeng Road, Guangzhou, 510120 People's Republic of China
| | - Junyao Xu
- Guandong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, #33 Yingfeng Road, Guangzhou, 510120 People's Republic of China
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Patterns of care and treatment outcomes in older patients with biliary tract cancer. Oncotarget 2016; 6:44995-5004. [PMID: 26575326 PMCID: PMC4792607 DOI: 10.18632/oncotarget.5707] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 10/27/2015] [Indexed: 12/17/2022] Open
Abstract
Background Although biliary tract cancers (BTC) are common in older age-groups, treatment approaches and outcomes are understudied in this population. Patients and Methods Data from 913 patients diagnosed with BTC from January 1987 to July 2013 and treated at Princess Margaret Cancer Center, Toronto were analyzed. The differences in treatment patterns between older and younger patients were explored and the impact of age, patient and disease characteristics on survival outcomes was assessed. Results Three hundred and twenty one patients ≥70 years were identified. Older patients were more likely to receive best supportive care, 40% (n = 130), compared to younger patients 26% (n = 154); p < 0.0001. On multivariable analysis, factors associated with receipt of surgery included stage I/II disease (p < 0.0001) and ECOG PS < 2 (p < 0.0001). Older age was not associated with lack of surgical intervention. In comparison, older age was associated with non-receipt of palliative chemotherapy (p = 0.0007). Similar survival benefit from treatment was seen in older and younger patients. Of 626 patients that underwent either surgery or palliative chemotherapy (n = 188), the median survival was 21.1 months (95% CI 19.0–27.9) in patients >70 years of age, and 21.1 months in younger patients (n = 438) (95% CI 19.5–24.5). Conclusion In this large retrospective analysis, older patients with BTC are less likely to undergo an intervention. However, active therapy when given is associated with similar survival benefits, irrespective of age.
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Liu Y, Sun J, Yang G, Liu Z, Guo S, Zhao R, Xu K, Wu X, Zhang Z. Downregulation of the expression of HDGF attenuates malignant biological behaviors of hilar cholangiocarcinoma cells. Mol Med Rep 2015; 12:4713-4719. [PMID: 26081074 DOI: 10.3892/mmr.2015.3922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 05/13/2015] [Indexed: 11/05/2022] Open
Abstract
Hepatoma-derived growth factor (HDGF) has been reported to be a potential predictive and prognostic marker for several types of cancer and important in malignant biological behaviors. However, its role in human hilar cholangiocarcinoma remains to be elucidated. Our previous study demonstrated that high expression levels of HDGF in hilar cholangiocarcinoma tissues correlates with tumor progression and patient outcome. The present study aimed to elucidate the detailed functions of the HDGF protein. This was performed by downregulating the protein expression of HDGF in the FRH0201 hilar cholangiocarcinoma cell line by RNA interference (RNAi) in vitro, and revealed that downregulation of the HDGF protein significantly inhibited the malignant biological behavior of the FRH0201 cells. In addition, further investigation revealed that downregulation of the protein expression of HDGF significantly decreased the secretion of vascular endothelial growth factor, which may be the mechanism partially responsible for the inhibition of malignant biological behaviors. These findings demonstrated that HDGF is important in promoting malignant biological behaviors, including proliferation, migration and invasion of hilar cholangiocarcinoma FRH0201 cells. Inhibition of the expression of HDGF downregulated the malignant biological behaviors, suggesting that downregulation of the protein expression of HDGF by RNAi may be a novel therapeutic approach to inhibit the progression of hilar cholangiocarcinoma.
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Affiliation(s)
- Yanfeng Liu
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jingxian Sun
- Department of Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250011, P.R. China
| | - Guangyun Yang
- Department of Hepatobiliary Surgery, The General Hospital of PLA, Beijing 100853, P.R. China
| | - Zhaojian Liu
- Institute of Cell Biology, Shandong University School of Medicine, Jinan, Shandong 250012, P.R. China
| | - Sen Guo
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Rui Zhao
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Kesen Xu
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiaopeng Wu
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Zhaoyang Zhang
- Department of Emergency Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Tan XY, Chang S, Liu W, Tang HH. Silencing of CXCR4 inhibits tumor cell proliferation and neural invasion in human hilar cholangiocarcinoma. Gut Liver 2013; 8:196-204. [PMID: 24672662 PMCID: PMC3964271 DOI: 10.5009/gnl.2014.8.2.196] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/24/2013] [Accepted: 04/16/2013] [Indexed: 12/25/2022] Open
Abstract
Background/Aims To evaluate the expression of CXC motif chemokine receptor 4 (CXCR4) in the tissues of patients with hilar cholangiocarcinoma (hilar-CCA) and to investigate the cell proliferation and frequency of neural invasion (NI) influenced by RNAi-mediated CXCR4 silencing. Methods An immunohistochemical technique was used to detect the expression of CXCR4 in 41 clinical tissues, including hilar-CCA, cholangitis, and normal bile duct tissues. The effects of small interference RNA (siRNA)-mediated CXCR4 silencing were detected in the hilar-CCA cell line QBC939. Cell proliferation was determined by MTT. Expression of CXCR4 was monitored by quantitative real time polymerase chain reaction and Western blot analysis. The NI ability of hilar-CCA cells was evaluated using a perineural cell and hilar-CCA cell coculture migration assay. Results The expression of CXCR4 was significantly induced in clinical hilar-CCA tissue. There was a positive correlation between the expression of CXCR4 and lymph node metastasis/NI in hilar-CCA patients (p<0.05). Silencing of CXCR4 in tumor cell lines by siRNA led to significantly decreased NI (p<0.05) and slightly decreased cell proliferation. Conclusions CXCR4 is likely correlated with clinical recurrence of hilar-CCA. CXCR4 is involved in the invasion and proliferation of human hilar-CCA cell line QBC939, indicating that CXCR4 could be a promising therapeutic target for hilar-CCA.
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Affiliation(s)
- Xin-Yu Tan
- Department of Emergency, Xiangya Hospital, Central-South University, Changsha, China
| | - Shi Chang
- Department of General Surgery, Xiangya Hospital, Central-South University, Changsha, China
| | - Wei Liu
- Department of Intensive Care Unit, Xiangya Hospital, Central-South University, Changsha, China
| | - Hui-Huan Tang
- Department of General Surgery, Xiangya Hospital, Central-South University, Changsha, China
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Lee BS, Hwang JH, Lee SH, Jang SE, Ahn DW, Hwang DW, Cho JY, Yoon YS, Han HS, Ahn S. Older adults with biliary tract cancer: treatment and prognosis. J Am Geriatr Soc 2012; 60:1862-71. [PMID: 23035728 DOI: 10.1111/j.1532-5415.2012.04163.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To compare survival in older (≥65) and younger (<65) individuals with biliary tract cancer (BTC) and to determine whether treatment efficacy varies according to age. DESIGN Retrospective cohort study and nested case-control study. SETTING Tertiary referral center in Korea. PARTICIPANTS Five hundred thirty-one individuals diagnosed with BTC from 2003 to 2011. MEASUREMENTS Demographic and clinical characteristics of 326 older (≥65) and 205 younger (<65) individuals with BTC were compared. Differences in survival were also assessed after matching according to propensity score. RESULTS There were no significant differences in sex, symptoms and signs, tumor histology, stage, or surgery between the two groups, but older participants had more comorbidities and poorer performance status and underwent less chemotherapy and radiotherapy (P < .05). Survival of the two groups was compared. After adjustment for baseline characteristics using the propensity score method, survival was still comparable (P = .72). When survival of older participants in the treatment group (TG, those who underwent surgery, chemotherapy, or radiotherapy) was compared with that of those in the supportive care group (SCG, those who received only supportive care), those in the TG had a longer survival time than those in the SCG (P < .001). This result was confirmed in the propensity analysis (including individuals undergoing surgery, P < .001; excluding individuals undergoing surgery, P < .001). In the multivariable Cox analysis, surgical resection and chemotherapy were significantly associated with longer survival, and advanced tumor stage, lower baseline serum albumin level, and greater comorbidity were found to significantly predict poor survival. Age was not associated with survival in individuals with BTC (P = .33). CONCLUSION Older age was not associated with poor survival in BTC, and treated individuals had longer survival in the older BTC population. Therefore, treatment should not be restricted on the basis of age.
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Affiliation(s)
- Ban S Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Liu YF, Zhao R, Guo S, Wang XQ, Lian PL, Chen YG, Xu KS. Expression and Clinical Significance of Hepatoma-Derived Growth Factor as a Prognostic Factor in Human Hilar Cholangiocarcinoma. Ann Surg Oncol 2010; 18:872-9. [DOI: 10.1245/s10434-010-1303-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Indexed: 12/17/2022]
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