Abstract 295P
Background
The prognostic factors for survival in perihilar cholangiocarcinoma (pCCA) included resection margin (RM) and lymph node metastases (LNM). Nevertheless, the contentious nature of the advantage associated with a negative RM in patients with LNM remains unresolved.
Methods
The present study retrospectively analyzed consecutive patients with pCCA who underwent surgical resection with or without adjuvant treatment at Sunpasitthiprasong Hospital between October 2013 and December 2018. The analysis excluded patients who experienced mortality within 90 days. The evaluation of overall survival was conducted based on the presence of LNM and the status of RM.
Results
Of the 172 resected pCCA patients, 87 (50.6%) were LNM negative, and 85 (49.4%) were LNM positive. Of the 87 LNM-negative patients, 66 (75.9%) were RM negative, and 21 (24.1%) were RM positive. In LNM-negative patients, overall survival was shorter in the RM positive than the RM-negative group (median survival time: 33.9 vs 15.6 months, respectively; p<0.001). Of the 85 LNM-positive patients, 34 (40.0%) were RM negative and 51 (60.0%) were RM positive. In LNM-positive patients, overall survival was remained worse in the RM positive compared to the RM negative group (median survival time: 9.7 vs 6.5 months, respectively; p=0.026). In addition, RM positive was an independent prognostic factor for overall survival in both univariable and multivariable analyses of LNM-negative and LNM-positive patients. Table: 295P
Univariable and multivariable analysis of prognostic factors for long-term survival in pCCA patient with LNM positive
| Characteristics | Univariable | Multivariable | ||||
| HR | 95%CI | p | HR | 95%CI | p | |
| Bismuth type IV | 1.297 | 0.735-2.287 | 0.369 | |||
| Blood transfusion | 1.403 | 0.871-2.259 | 0.161 | |||
| Tumor size (cm) >3 cm | 1.683 | 1.018-2.781 | 0.040 | 1.705 | 0.913-3.184 | 0.094 |
| Positive resection margin | 1.696 | 1.061-2.711 | 0.026 | 2.031 | 1.162-3.551 | 0.013 |
| pT3-4 staging | 0.798 | 0.508-1.253 | 0.326 | |||
| Moderate/Poor differentiation | 1.561 | 0.930-2.621 | 0.089 | |||
| Lymphovascular invasion | 0.389 | 0.209-0.726 | 0.002 | 0.393 | 0.209-0.740 | 0.004 |
| Perineural invasion | 0.631 | 0.194-2.052 | 0.439 | |||
| Vascular invasion | 0.865 | 0.543-1.380 | 0.543 |
Conclusions
In patients with perihilar cholangiocarcinoma, the RM status was an important prognostic factor for both LNM-negative and LNM-positive patients.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.