Differences in Prognostic Factors and Recurrence Patterns After Curative-Intent Resection of Perihilar and Distal...

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastrointestinal oncology

Background:

• Perihilar cholangiocarcinoma (pCCA) and distal cholangiocarcinoma (dCCA) are distinct biliary tract cancers.
• Despite arising from similar tissues, differing surgical approaches are employed for pCCA and dCCA.
• Comparative outcomes, prognostic factors, and recurrence patterns between pCCA and dCCA remain incompletely understood.

Purpose of the Study:

• To compare survival outcomes, prognostic factors, and recurrence patterns between patients with perihilar cholangiocarcinoma and distal cholangiocarcinoma.
• To identify specific predictors of survival and disease recurrence for each cholangiocarcinoma subtype.

Main Methods:

• Retrospective analysis of patients undergoing curative-intent resection for pCCA or dCCA between 2000 and 2015.
• Kaplan-Meier analysis and Cox regression modeling were used to determine survival and prognostic factors.

Main Results:

• No significant differences in median overall survival or disease-free survival were observed between pCCA and dCCA.
• For pCCA, age > 65 and need for bile duct re-resection predicted poorer survival. For dCCA, positive lymph nodes (pN1) and elevated preoperative CA19-9 predicted poorer outcomes.
• Local recurrence was more frequent in pCCA, whereas multiple synchronous recurrence sites were more common in dCCA.

Conclusions:

• Perihilar cholangiocarcinoma and distal cholangiocarcinoma exhibit comparable survival rates post-resection.
• Local tumor control is a key prognostic indicator for pCCA, while lymph node status is critical for dCCA prognosis.
• Understanding these distinct prognostic factors is essential for tailoring treatment strategies and improving patient outcomes.