Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Survival analysis of extrahepatic cholangiocarcinoma based on surveillance, epidemiology, and end results database

  • Hassam Ali (Department of Internal Medicine, East Carolina University) ;
  • Joshua Zweigle (Department of Internal Medicine, East Carolina University) ;
  • Pratik Patel (Department of Gastroenterology, Mather Hospital/Hofstra University School of Medicine) ;
  • Brandon Tedder (Department of Internal Medicine, East Carolina University) ;
  • Rafeh Khan (Department of Internal Medicine, University of Health Sciences) ;
  • Saurabh Agrawal (Department of Hepatology, Tampa General Hospital)
  • Received : 2022.09.20
  • Accepted : 2022.11.03
  • Published : 2023.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Backgrounds/Aims: Cholangiocarcinoma (CCA) can be classified as intrahepatic CCA or extrahepatic CCA (eCCA). We intended to analyze and reports the survival outcomes for eCCA. Methods: Surveillance, epidemiology, and end results (SEER) registry, site recode C24.0, was used to select cases of eCCA from 2000 to 2018. Patients with incomplete data or ages <18 years were excluded. Results: Male (52.69%) and White race (77.99%) predominated. Compared with 2000-2006, survival increased in 2013 (adjusted hazard ratio [HRadj]: 0.68, 95% confidence interval [CI] 0.58-0.70; p < 0.01). Surgery with chemoradiotherapy (HRadj: 0.69, 95% CI 0.60-0.7; p < 0.01) and surgery with chemotherapy (HRadj: 0.72, 95% CI 0.62-0.83; p < 0.01) improved survival over surgery alone. Compared with surgery without lymph node (LN) removal, surgery of four or more regional LN reduced the risk of death by 58% (HRadj: 0.42, 95% CI 0.36-0.51; p < 0.01). Compared with patients without surgery, patients who underwent bile duct excision (HRadj: 0.82, 95% CI 0.72-0.94; p < 0.01), simple or extended lobectomy (HRadj: 0.85, 95% CI 0.75-0.95; p = 0.009), and hepatectomy (HRadj: 0.80, 95% CI 0.72-0.88; p < 0.01) significantly improved survival. Patients with distal CCA had a 17% higher survival than perihilar CCA (HRadj: 0.83, 95% CI 0.74-0.92; p < 0.01) and LN dissection was equally beneficial for both subgroups (p < 0.01). Conclusions: Surgery with chemoradiotherapy has a proven increase in the 5-year survival of the eCCA. LN resection, bile duct excision, lobectomy, and hepatectomy have better outcomes.

Keywords

References

  1. Zhang H, Yang T, Wu M, Shen F. Intrahepatic cholangiocarcinoma: epidemiology, risk factors, diagnosis and surgical management. Cancer Lett 2016;379:198-205.  https://doi.org/10.1016/j.canlet.2015.09.008
  2. Ali H, Tedder B, Waqar SH, Mohamed R, Cate EL, Ali E. Changing incidence and survival of intrahepatic cholangiocarcinoma based on Surveillance, Epidemiology, and End Results Database (2000-2017). Ann Hepatobiliary Pancreat Surg 2022;26:235-243.  https://doi.org/10.14701/ahbps.21-173
  3. Blechacz B, Komuta M, Roskams T, Gores GJ. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 2011;8:512-522.  https://doi.org/10.1038/nrgastro.2011.131
  4. Liao P, Cao L, Chen H, Pang SZ. Analysis of metastasis and survival between extrahepatic and intrahepatic cholangiocarcinoma: a large population-based study. Medicine (Baltimore) 2021;100:e25635. 
  5. Marcano-Bonilla L, Mohamed EA, Mounajjed T, Roberts LR. Biliary tract cancers: epidemiology, molecular pathogenesis and genetic risk associations. Chin Clin Oncol 2016;5:61. 
  6. Forner A, Vidili G, Rengo M, Bujanda L, Ponz-Sarvise M, Lamarca A. Clinical presentation, diagnosis and staging of cholangiocarcinoma. Liver Int 2019;39 Suppl 1:98-107.  https://doi.org/10.1111/liv.14086
  7. Welzel TM, McGlynn KA, Hsing AW, O'Brien TR, Pfeiffer RM. Impact of classification of hilar cholangiocarcinomas (Klatskin tumors) on the incidence of intra- and extrahepatic cholangiocarcinoma in the United States. J Natl Cancer Inst 2006;98:873-875.  https://doi.org/10.1093/jnci/djj234
  8. Surveillance Research Program, NCIs Division of Cancer Control and Population Sciences. SEER Registries [Internet]. Washington, D.C.: National Cancer Institute 2021 [cited 2021 Sep 29]. Available from: https://seer.cancer.gov/. 
  9. Surveillance Research Program, National Cancer Institute. SEER*Stat SEER*Stat  SEER*Stat software version 8.3.9.2 [Internet]. Washington, D.C.: National Cancer Institute 2021 [cited 2021 Sep 29]. Available from: https://seer.cancer.gov/seerstat/. 
  10. Brar G, Greten TF, Graubard BI, McNeel TS, Petrick JL, McGlynn KA, et al. Hepatocellular carcinoma survival by etiology: a SEER-medicare database analysis. Hepatol Commun 2020;4:1541-1551.  https://doi.org/10.1002/hep4.1564
  11. Ali H, Pamarthy R, Vallabhaneni M, Sarfraz S, Ali H, Rafique H. Pancreatic cancer incidence trends in the United States from 2000-2017: analysis of Surveillance, Epidemiology and End Results (SEER) database. F1000Res 2021;10:529. 
  12. Mao K, Liu J, Sun J, Zhang J, Chen J, Pawlik TM, et al. Patterns and prognostic value of lymph node dissection for resected perihilar cholangiocarcinoma. J Gastroenterol Hepatol 2016;31:417-426.  https://doi.org/10.1111/jgh.13072
  13. Zhang Y, Wu Z, Wang X, Li C, Chang J, Jiang W, et al. Development and external validation of a nomogram for predicting the effect of tumor size on survival of patients with perihilar cholangiocarcinoma. BMC Cancer 2020;20:1044. 
  14. Liu WW, Tu JF, Ying XH, Chen ZJ, Wang YB. Postoperative survival of extrahepatic and intrahepatic cholangiocarcinoma after surgery: a population-based cohort. BMJ Open 2022;12:e049789. 
  15. Clements O, Eliahoo J, Kim JU, Taylor-Robinson SD, Khan SA. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a systematic review and meta-analysis. J Hepatol 2020;72:95-103.  https://doi.org/10.1016/j.jhep.2019.09.007
  16. Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepatology 2011;54:173-184.  https://doi.org/10.1002/hep.24351
  17. Shaib Y, El-Serag HB. The epidemiology of cholangiocarcinoma. Semin Liver Dis 2004;24:115-125.  https://doi.org/10.1055/s-2004-828889
  18. Sripa B, Pairojkul C. Cholangiocarcinoma: lessons from Thailand. Curr Opin Gastroenterol 2008;24:349-356.  https://doi.org/10.1097/MOG.0b013e3282fbf9b3
  19. Lim JH. Liver flukes: the malady neglected. Korean J Radiol 2011;12:269-279.  https://doi.org/10.3348/kjr.2011.12.3.269
  20. Gad MM, Saad AM, Faisaluddin M, Gaman MA, Ruhban IA, Jazieh KA, et al. Epidemiology of cholangiocarcinoma; United States incidence and mortality trends. Clin Res Hepatol Gastroenterol 2020;44:885-893.  https://doi.org/10.1016/j.clinre.2020.03.024
  21. Molodecky NA, Kareemi H, Parab R, Barkema HW, Quan H, Myers RP, et al. Incidence of primary sclerosing cholangitis: a systematic review and meta-analysis. Hepatology 2011;53:1590-1599.  https://doi.org/10.1002/hep.24247
  22. Bird NTE, McKenna A, Dodd J, Poston G, Jones R, Malik H. Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma. Br J Surg 2018;105:1408-1416.  https://doi.org/10.1002/bjs.10921
  23. Jang JY, Kim SW, Park DJ, Ahn YJ, Yoon YS, Choi MG, et al. Actual long-term outcome of extrahepatic bile duct cancer after surgical resection. Ann Surg 2005;241:77-84.  https://doi.org/10.1097/01.sla.0000150166.94732.88
  24. Hoehn RS, Wima K, Ertel AE, Meier A, Ahmad SA, Shah SA, et al. Adjuvant chemotherapy and radiation therapy is associated with improved survival for patients with extrahepatic cholangiocarcinoma. Ann Surg Oncol 2015;22 Suppl 3:S1133-S1139.  https://doi.org/10.1245/s10434-015-4599-8
  25. Ren F, Zhang J, Gao Z, Zhu H, Chen X, Liu W, et al. Racial disparities in the survival time of patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma between Chinese patients and patients of other racial groups: a population-based study from 2004 to 2013. Oncol Lett 2018;16:7102-7116.  https://doi.org/10.3892/ol.2018.9550
  26. Wang F, Liu Y, Zhang H. Loss of MTSS1 expression is an independent prognostic factor for Hilar cholangiocarcinoma. Pathol Oncol Res 2013;19:815-820.  https://doi.org/10.1007/s12253-013-9649-6
  27. Stewart SL, Kwong SL, Bowlus CL, Nguyen TT, Maxwell AE, Bastani R, et al. Racial/ethnic disparities in hepatocellular carcinoma treatment and survival in California, 1988-2012. World J Gastroenterol 2016;22:8584-8595.  https://doi.org/10.3748/wjg.v22.i38.8584
  28. Barr Fritcher EG, Voss JS, Brankley SM, Campion MB, Jenkins SM, Keeney ME, et al. An optimized set of fluorescence in situ hybridization probes for detection of pancreatobiliary tract cancer in cytology brush samples. Gastroenterology 2015;149:1813-1824.e1.  https://doi.org/10.1053/j.gastro.2015.08.046
  29. Ebata T, Mizuno T, Yokoyama Y, Igami T, Sugawara G, Nagino M. Surgical resection for Bismuth type IV perihilar cholangiocarcinoma. Br J Surg 2018;105:829-838.  https://doi.org/10.1002/bjs.10556
  30. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010;362:1273-1281.  https://doi.org/10.1056/NEJMoa0908721
  31. Primrose JN, Fox RP, Palmer DH, Malik HZ, Prasad R, Mirza D, et al. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol 2019;20:663-673. Erratum in: Lancet Oncol 2019;20:e242.  https://doi.org/10.1016/S1470-2045(18)30915-X
  32. Darwish Murad S, Heimbach JK, Gores GJ, Rosen CB, Benson JT, Kim WR. Excellent quality of life after liver transplantation for patients with perihilar cholangiocarcinoma who have undergone neoadjuvant chemoradiation. Liver Transpl 2013;19:521-528.  https://doi.org/10.1002/lt.23630
  33. Buettner S, Galjart B, van Vugt JLA, Bagante F, Alexandrescu S, Marques HP, et al. Performance of prognostic scores and staging systems in predicting long-term survival outcomes after surgery for intrahepatic cholangiocarcinoma. J Surg Oncol 2017;116:1085-1095.  https://doi.org/10.1002/jso.24759
  34. Liu ZP, Zhang QY, Chen WY, Huang YY, Zhang YQ, Gong Y, et al. Evaluation of four lymph node classifications for the prediction of survival in hilar cholangiocarcinoma. J Gastrointest Surg 2022;26:1030-1040.  https://doi.org/10.1007/s11605-021-05211-x
  35. Kim HJ, Kim CY, Hur YH, Koh YS, Kim JC, Kim HJ, et al. Prognostic factors for survival after curative resection of distal cholangiocarcinoma: perineural invasion and lymphovascular invasion. Surg Today 2014;44:1879-1886.  https://doi.org/10.1007/s00595-014-0846-z
  36. Waseem D, Tushar P. Intrahepatic, perihilar and distal cholangiocarcinoma: management and outcomes. Ann Hepatol 2017;16:133-139.  https://doi.org/10.5604/16652681.1226927
  37. Valero V 3rd, Cosgrove D, Herman JM, Pawlik TM. Management of perihilar cholangiocarcinoma in the era of multimodal therapy. Expert Rev Gastroenterol Hepatol 2012;6:481-495. https://doi.org/10.1586/egh.12.20