P-124 - Clinical outcome and impact of lymph node level assessment in biliary tract cancers

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Hepatobiliary Cancers
Pathology/Molecular Biology
Presenter J. Martinez-Galán
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors J. Martinez-Galán1, C. González-Rivas1, L. Castillo1, E. González-Flores1, J. Ruiz-Vozmediano1, L. Ochoa2, V. Amezcua3, J. García-García1, J.R. Delgado1, V. Conde1, J.A. Ortega1
  • 1Hospital Universitario Virgen de las Nieves, Granada/ES
  • 2SAS, Granada/ES
  • 3H.U. Virgen de las Nieves, Granada/ES

Abstract

Introduction

Biliary tract cancers (BTCs) are relatively rare neoplasms encompass both cholangiocarcinoma (CC). The role of routine lymphadenectomy at the time of surgical resection remains poorly defined. We sought to identify factors associated with outcome following and examine the impact of lymph node (LN) assessment on survival

Methods

43 patients who underwent curative intent surgery between 2000-2013 were identified from a database. We calculated prognostic factors and impact lymph node (LN) assessment for survival.

Results

A total of 43 patients were identified with no metastatic BTCs. The median age was 65 years (29–82 years); performance status of 0 in 33/43 (76%); PS1 in 8/43 (19%) and PS2 in 2/43 (5%) pts. A histological diagnosis of adenocarcinoma was confirmed in 100%. Surgical resection was performed in all patients. After resection 42% (18/43) had positive nodes. Adjuvant chemotherapy had 31/43(72%), preferred with gemcitabine and a median number of cycles 6. Grade 3 or 4 toxicities rarely occurred. During median follow-up of 6.6 years tumor recurrence or metastatic disease occurred in 63% with median survival global were 2 years and 1.5 years for disease free survival. For stage T, the median survival global rates were 58 months (95% CI 44.6-71.3) for T1-T2 and 35 months (95% CI 23.3-46.8) for T3-T4 (p = 0.015) and for median recidive-free survival were 23 months (95% CI 11.8-34) for T1-T2 and 14 months (95% CI 6.5-21) for T3-T4 (p = 0.05). For N stage, the median survival global were 58 months (95% CI 50.5-65.4) for negative nodes and 26 months (95% CI 3.7-48.2) for positive nodes (p = 0.003) and for median recidive-free survival were 55 months (95% CI 31.7-57.5) for negative nodes and 10 months (95% CI 6.8-13) for positive nodes (p = 0.006). The patients who had nodal affectation in hepatic hilum had better recidive-free survival that those patients who had nodal affectation in celiac trunk p < 0.05.

Conclusion

This represents a biliary cancer cohort with survival benchmarks obtained in the modern era of multidisciplinary care. Surgical resection and adjuvant chemotherapy offers the optimal treatment outcome in patients with ICC. From our results depth of tumor invasion (T), the presence the lymph node metastases (N) and level nodal affections are the strongest predictors of relapse and survival