High-grade dysplasia/carcinoma in situ of the bile duct margin in patients with surgically resected node-negative perihilar cholangiocarcinoma is associated with poor survival: a retrospective study

J Hepatobiliary Pancreat Sci. 2017 Aug;24(8):456-465. doi: 10.1002/jhbp.481. Epub 2017 Jul 3.

Abstract

Background: The clinical relevance of a high-grade dysplasia/carcinoma in situ (HD/CIS)-positive bile duct margin in perihilar cholangiocarcinoma (PHC) is unclear. We evaluated the surgical outcomes of PHC patients with HD/CIS.

Methods: Clinicopathological data of 163 consecutive patients who underwent resection of PHC between 2004 and 2013 were analyzed retrospectively.

Results: Postoperative states included curative resection (R0) with free margins in 113 patients, non-curative resection with HD/CIS (R1-HD/CIS) in 22 patients, and non-curative resection with any invasive carcinoma margin in 28 patients. Multivariate analyses in the entire cohort showed that lymph node metastasis (hazard ratio [HR] 1.91), distant metastasis (HR 3.87), and non-curative resection with any invasive carcinoma margin (vs. R0; HR 2.06) were significant independent prognosticators. However, in node-negative and distant metastasis-negative PHC patients, histology (HR 2.97), R1-HD/CIS (vs. R0; HR 2.31), and non-curative resection with any invasive carcinoma margin (vs. R0; HR 5.33) were significant independent prognosticators. The 2- and 5-year disease-specific survival rates in node-negative and distant metastasis-negative PHC patients with R1-HD/CIS margins were lower compared with those in patients with R0 margins (2-year, 76.7% vs. 84.3%; 5-year, 37.5% vs. 69.3%; P = 0.026).

Conclusions: R1-HD/CIS should be avoided in patients undergoing surgery for node-negative and distant metastasis-negative PHC.

Keywords: Biliary tract neoplasms; Margins of excision; Pathology; Prognosis; Surgery.

Publication types

  • Evaluation Study

MeSH terms

  • Analysis of Variance
  • Bile Duct Neoplasms / diagnostic imaging
  • Bile Duct Neoplasms / mortality*
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / surgery*
  • Carcinoma in Situ / mortality
  • Carcinoma in Situ / pathology
  • Carcinoma in Situ / surgery
  • Cause of Death
  • Cohort Studies
  • Disease-Free Survival
  • Female
  • Hepatectomy / methods*
  • Hepatectomy / mortality
  • Humans
  • Japan
  • Klatskin Tumor / diagnostic imaging
  • Klatskin Tumor / mortality*
  • Klatskin Tumor / pathology
  • Klatskin Tumor / surgery*
  • Lymph Nodes / pathology
  • Male
  • Margins of Excision
  • Multivariate Analysis
  • Neoplasm Invasiveness / pathology
  • Neoplasm Recurrence, Local / mortality*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis
  • Treatment Outcome