Nooijen, Lynn E. and Banales, Jesus M. and de Boer, Marieke T. and Braconi, Chiara and Folseraas, Trine and Forner, Alejandro and Holowko, Waclaw and Hoogwater, Frederik J. H. and Klumpen, Heinz-Josef and Koerkamp, Bas Groot and Lamarca, Angela and La Casta, Adelaida and Lopez-Lopez, Flora and Izquierdo-Sanchez, Laura and Scheiter, Alexander and Utpatel, Kirsten and Swijnenburg, Rutger-Jan and Kazemier, Geert and Erdmann, Joris (2022) Impact of Positive Lymph Nodes and Resection Margin Status on the Overall Survival of Patients with Resected Perihilar Cholangiocarcinoma: The ENSCCA Registry. CANCERS, 14 (10): 2389. ISSN , 2072-6694
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Simple Summary Lymph node metastasis and positive resection margins have been reported to be major determinants of overall survival (OS) and poor recurrence-free survival (RFS) for patients after resection for perihilar cholangiocarcinoma (pCCA). The aim of current study was to assess the prognostic value of positive lymph nodes and resection margin status on OS. We found a major negative effect of positive lymph nodes on survival and recurrence, which, surprisingly, was independent of margin status. ECOG performance status, positive lymph nodes, and the grade of tumor differentiation were found as the main independent indicators of oncological outcome. This suggests that tumor biology and performance status have a higher impact on survival than extended or radical surgery. Background: Lymph node metastasis and positive resection margins have been reported to be major determinants of overall survival (OS) and poor recurrence-free survival (RFS) for patients who underwent resection for perihilar cholangiocarcinoma (pCCA). However, the prognostic value of positive lymph nodes independently from resection margin status on OS has not been evaluated. Methods: From the European Cholangiocarcinoma (ENSCCA) registry, patients who underwent resection for pCCA between 1994 and 2021 were included in this retrospective cohort study. The primary outcome was OS stratified for resection margin and lymph node status. The secondary outcome was recurrence-free survival. Results: A total of 325 patients from 11 different centers and six European countries were included. Of these, 194 (59.7%) patients had negative resection margins. In 113 (34.8%) patients, positive lymph nodes were found. Lymph node status, histological grade, and ECOG performance status were independent prognostic factors for survival. The median OS for N0R0, N0R1, N+R0, and N+R1 was 38, 30, 18, and 12 months, respectively (p < 0.001). Conclusion: These data indicate that in the presence of positive regional lymph nodes, resection margin status does not determine OS or RFS in patients with pCCA. Achieving negative margins in patients with positive nodes should not come at the expense of more extensive surgery and associated higher mortality.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | EXTERNAL VALIDATION; SURGICAL-TREATMENT; 8TH EDITION; CANCER; perihilar cholangiocarcinoma; lymph nodes; resection margin; overall survival; recurrence-free survival |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Pathologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 12 Dec 2023 12:24 |
| Last Modified: | 12 Dec 2023 12:24 |
| URI: | https://pred.uni-regensburg.de/id/eprint/58745 |
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