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Risk Factors for Distant Metastasis in Extrahepatic Bile Duct Cancer after Curative Resection (KROG 1814).

Authors
  • Park, Younghee1
  • Kim, Tae Hyun2
  • Kim, Kyubo1
  • Yu, Jeong Il3
  • Jung, Wonguen1
  • Seong, Jinsil4
  • Kim, Woo Chul5
  • Choi, Jin Hwa6
  • Chang, Ah Ram7
  • Jeong, Bae Kwon8
  • Kim, Byoung Hyuck9
  • Kim, Tae Gyu10
  • Kim, Jin Hee11
  • Park, Hae Jin12
  • Shin, Hyun Soo13
  • Im, Jung Ho13
  • Chie, Eui Kyu14
  • 1 Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea. , (North Korea)
  • 2 Center for Proton Therapy, National Cancer Center, Goyang, Korea. , (North Korea)
  • 3 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. , (North Korea)
  • 4 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea. , (North Korea)
  • 5 Department of Radiation Oncology, Inha University School of Medicine, Incheon, Korea. , (North Korea)
  • 6 Department of Radiation Oncology, Chung-Ang University College of Medicine, Seoul, Korea. , (North Korea)
  • 7 Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea. , (North Korea)
  • 8 Department of Radiation Oncology, Gyeongsang National University College of Medicine, Jinju, Korea. , (North Korea)
  • 9 Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. , (North Korea)
  • 10 Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. , (North Korea)
  • 11 Department of Radiation Oncology, Keimyung University School of Medicine, Daegu, Korea. , (North Korea)
  • 12 Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea. , (North Korea)
  • 13 Department of Radiation Oncology, CHA University School of Medicine, Seongnam, Korea. , (North Korea)
  • 14 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. , (North Korea)
Type
Published Article
Journal
Cancer research and treatment
Publication Date
Jan 01, 2024
Volume
56
Issue
1
Pages
272–279
Identifiers
DOI: 10.4143/crt.2023.616
PMID: 37536713
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Risk factors predicting distant metastasis (DM) in extrahepatic bile duct cancer (EHBDC) patients treated with curative resection were investigated. Medical records of 1,418 EHBDC patients undergoing curative resection between Jan 2000 and Dec 2015 from 14 institutions were reviewed. After resection, 924 patients (67.6%) were surveilled without adjuvant therapy, 297 (21.7%) were treated with concurrent chemoradiotherapy (CCRT) and 148 (10.8%) with CCRT followed by chemotherapy. To exclude the treatment effect from innate confounders, patients not treated with adjuvant therapy were evaluated. After a median follow-up of 36.7 months (range, 2.7 to 213.2 months), the 5-year distant metastasis-free survival (DMFS) rate was 57.7%. On multivariate analysis, perihilar or diffuse tumor (hazard ratio [HR], 1.391; p=0.004), poorly differentiated histology (HR, 2.014; p < 0.001), presence of perineural invasion (HR, 1.768; p < 0.001), positive nodal metastasis (HR, 2.670; p < 0.001) and preoperative carbohydrate antigen (CA) 19-9 ≥ 37 U/mL (HR, 1.353; p < 0.001) were significantly associated with inferior DMFS. The DMFS rates significantly differed according to the number of these risk factors. For validation, patients who underwent adjuvant therapy were evaluated. In patients with ≥ 3 factors, additional chemotherapy after CCRT resulted in a superior DMFS compared with CCRT alone (5-year rate, 47.6% vs. 27.7%; p=0.001), but the benefit of additional chemotherapy was not observed in patients with 0-2 risk factors. Tumor location, histologic differentiation, perineural invasion, lymph node metastasis, and preoperative CA 19-9 level predicted DM risk in resected EHBDC. These risk factors might help identifying a subset of patients who could benefit from additional chemotherapy after resection.

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