Tadafumi Asaoka1,2, Shogo Kobayashi3, Takehiko Hanaki3, Yoshifumi Iwagami3, Yoshito Tomimaru3, Hirofumi Akita3, Takehiro Noda3, Kunihito Gotoh3, Yutaka Takeda3,4, Masahiro Tanemura3,5, Yuichiro Doki3, Hidetoshi Eguchi3. 1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan. tasaoka@gesurg.med.osaka-u.ac.jp. 2. Department of Surgery, Osaka Police Hospital, Osaka, Japan. tasaoka@gesurg.med.osaka-u.ac.jp. 3. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan. 4. Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan. 5. Department of Surgery, Rinku General Medical Center, Osaka, Japan.
Abstract
PURPOSE: This study aimed to identify prognostic factors for patients with ICC after a curative resection and clarify the appropriate indications for surgical resection and postoperative adjuvant chemotherapy. METHODS: This retrospective study included 81 patients who underwent curative resection for ICC between April 1995 and December 2014. Kaplan-Meier and Cox regression models were used to analyze the effects of clinicopathological features on overall and recurrence-free survival. RESULTS: The cumulative 5-year overall survival of 81 patients was 57.2%, and the 5-year recurrence-free survival was 24.0%. The multivariate analysis identified the lymph node status and preoperative CA19-9 levels as independent prognostic factors for overall survival. The 5-year overall survival rates were 79.9% and 38.7% in patients with normal and elevated CA19-9, respectively (p < 0.0001). The 5-year overall survival rates of patients with and without nodal metastasis were 33.7% and 60.9%, respectively (p = 0.0007). After adjusting for prognostic factors identified in a Cox regression analysis, we found that nodal-positive disease was significantly associated with benefit from adjuvant chemotherapy (HR 0.32, p = 0.03). CONCLUSIONS: Surgical resection with curative intent combined with regional lymph node dissection should be indicated for ICC patients with normal CA19-9 levels. Postoperative adjuvant chemotherapy should be administered to high-risk patients with a positive nodal status.
PURPOSE: This study aimed to identify prognostic factors for patients with ICC after a curative resection and clarify the appropriate indications for surgical resection and postoperative adjuvant chemotherapy. METHODS: This retrospective study included 81 patients who underwent curative resection for ICC between April 1995 and December 2014. Kaplan-Meier and Cox regression models were used to analyze the effects of clinicopathological features on overall and recurrence-free survival. RESULTS: The cumulative 5-year overall survival of 81 patients was 57.2%, and the 5-year recurrence-free survival was 24.0%. The multivariate analysis identified the lymph node status and preoperative CA19-9 levels as independent prognostic factors for overall survival. The 5-year overall survival rates were 79.9% and 38.7% in patients with normal and elevated CA19-9, respectively (p < 0.0001). The 5-year overall survival rates of patients with and without nodal metastasis were 33.7% and 60.9%, respectively (p = 0.0007). After adjusting for prognostic factors identified in a Cox regression analysis, we found that nodal-positive disease was significantly associated with benefit from adjuvant chemotherapy (HR 0.32, p = 0.03). CONCLUSIONS: Surgical resection with curative intent combined with regional lymph node dissection should be indicated for ICC patients with normal CA19-9 levels. Postoperative adjuvant chemotherapy should be administered to high-risk patients with a positive nodal status.
Authors: Jae Pil Hwang; Jong Ho Moon; Hee Kyung Kim; Min Hee Lee; Chae Hong Lim; Soo Bin Park; Joon-Kee Yoon; Jung Mi Park Journal: Medicine (Baltimore) Date: 2021-05-28 Impact factor: 1.817