P-0145 - Relation of lymph node level assessment on prognosis after surgical resection in biliary tract cancers

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Hepatobiliary Cancers
Surgery and/or Radiotherapy of Cancer
Presenter Joaquina Martinez-Galán
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors C. González-Rivas1, J. Ruiz-Vozmediano1, L. Castillo-Portellano1, L. Ochoa2, V. Conde-Herrero1, J. García-García1, R. Delgado Pérez Juan1
  • 1Hospital Universitario Virgen de las Nieves, Granada/ES
  • 2SAS, Granada/ES

Abstract

Introduction

Biliary tract cancers (BTCs) are relatively rare neoplasms encompassing 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 2000-2010 were identified from a database. We calculated prognostics factors and impact lymph node assessment for survival.

Results

A total of 43 patients were identified with no metastatic BCTs. The median age was 65 years (29-82 years); performance status 0 in 33/43 (76%); PS 1 in 8/43 (19%) and PS 2 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 6 cycles. 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 hilio had better recidive free survival that those patients who had nodal affection 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 ours results depth tumor invasion (T), the presence the lymph node metastases (N) and level nodal affectation are the strongest predictor of relapse and survival.