Diamantis I Tsilimigras1, J Madison Hyer1, Anghela Z Paredes1, Dimitrios Moris1, Kota Sahara1, Alfredo Guglielmi2, Luca Aldrighetti3, Matthew Weiss4, Todd W Bauer5, Sorin Alexandrescu6, George A Poultsides7, Shishir K Maithel8, Hugo P Marques9, Guillaume Martel10, Carlo Pulitano11, Feng Shen12, Olivier Soubrane13, Bas Groot Koerkamp14, Itaru Endo15, Kazunari Sasaki16, Federico Aucejo16, Xu-Feng Zhang17, Timothy M Pawlik18. 1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. 2. Department of Surgery, University of Verona, Verona, Italy. 3. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 4. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 5. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 6. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 7. Department of Surgery, Stanford University, Stanford, CA, USA. 8. Department of Surgery, Emory University, Atlanta, GA, USA. 9. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 10. Department of Surgery, University of Ottawa, Ottawa, Canada. 11. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 12. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France. 14. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. 15. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan. 16. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USA. 17. Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 18. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. tim.pawlik@osumc.edu.
Abstract
INTRODUCTION: While tumor burden (TB) has been associated with outcomes among patients with hepatocellular carcinoma, the role of overall TB in intrahepatic cholangiocarcinoma (ICC) remains poorly defined. METHODS: Patients undergoing curative-intent resection of ICC between 2000 and 2017 were identified from a multi-institutional database. The impact of TB on overall (OS) and disease-free survival (DFS) was evaluated in the multi-institutional database and validated externally. RESULTS: Among 1101 patients who underwent curative-intent resection of ICC, 624 (56.7%) had low TB, 346 (31.4%) medium TB, and 131 (11.9%) high TB. OS incrementally worsened with higher TB (5-year OS; low TB: 48.3% vs medium TB: 29.8% vs high TB: 17.3%, p < 0.001). Similarly, patients with low TB had better DFS compared with medium and high TB patients (5-year DFS: 38.3% vs 18.7% vs 6.9%, p < 0.001). On multivariable analysis, TB was independently associated with OS (medium TB: HR = 1.40, 95% CI 1.14-1.71; high TB: HR = 1.89, 95% CI 1.46-2.45) and DFS (medium TB, HR = 1.61, 95% CI 1.33-1.96; high TB: HR = 2.03, 95% CI 1.56-2.64). Survival analysis revealed an excellent prognostic discrimination using the TB among the external validation cohort (3-year OS; low TB: 44.8%, medium TB: 29.3%; high TB: 23.3%, p = 0.03; 3-year DFS: low TB: 32.7%, medium TB: 10.7%; high TB: 0%, p < 0.001). While neoadjuvant chemotherapy was not associated with survival across the TB groups, receipt of adjuvant chemotherapy was associated with increased survival among patients with high TB (5-year OS: 24.4% vs 13.4%, p = 0.02). CONCLUSION: Overall TB dictated prognosis among patients with resectable ICC. TB may be used as a tool to help guide post-resection treatment strategies.
INTRODUCTION: While tumor burden (TB) has been associated with outcomes among patients with hepatocellular carcinoma, the role of overall TB in intrahepatic cholangiocarcinoma (ICC) remains poorly defined. METHODS:Patients undergoing curative-intent resection of ICC between 2000 and 2017 were identified from a multi-institutional database. The impact of TB on overall (OS) and disease-free survival (DFS) was evaluated in the multi-institutional database and validated externally. RESULTS: Among 1101 patients who underwent curative-intent resection of ICC, 624 (56.7%) had low TB, 346 (31.4%) medium TB, and 131 (11.9%) high TB. OS incrementally worsened with higher TB (5-year OS; low TB: 48.3% vs medium TB: 29.8% vs high TB: 17.3%, p < 0.001). Similarly, patients with low TB had better DFS compared with medium and high TB patients (5-year DFS: 38.3% vs 18.7% vs 6.9%, p < 0.001). On multivariable analysis, TB was independently associated with OS (medium TB: HR = 1.40, 95% CI 1.14-1.71; high TB: HR = 1.89, 95% CI 1.46-2.45) and DFS (medium TB, HR = 1.61, 95% CI 1.33-1.96; high TB: HR = 2.03, 95% CI 1.56-2.64). Survival analysis revealed an excellent prognostic discrimination using the TB among the external validation cohort (3-year OS; low TB: 44.8%, medium TB: 29.3%; high TB: 23.3%, p = 0.03; 3-year DFS: low TB: 32.7%, medium TB: 10.7%; high TB: 0%, p < 0.001). While neoadjuvant chemotherapy was not associated with survival across the TB groups, receipt of adjuvant chemotherapy was associated with increased survival among patients with high TB (5-year OS: 24.4% vs 13.4%, p = 0.02). CONCLUSION: Overall TB dictated prognosis among patients with resectable ICC. TB may be used as a tool to help guide post-resection treatment strategies.
Authors: Joshua S Jolissaint; Tiegong Wang; Kevin C Soares; Joanne F Chou; Mithat Gönen; Linda M Pak; Thomas Boerner; Richard K G Do; Vinod P Balachandran; Michael I D'Angelica; Jeffrey A Drebin; T P Kingham; Alice C Wei; William R Jarnagin; Jayasree Chakraborty Journal: HPB (Oxford) Date: 2022-02-17 Impact factor: 3.842
Authors: Catherine Alix-Panabieres; Anthony Magliocco; Luis Enrique Cortes-Hernandez; Zahra Eslami-S; Daniel Franklin; Jane L Messina Journal: Clin Exp Metastasis Date: 2021-05-07 Impact factor: 5.150
Authors: Joshua S Jolissaint; Kevin C Soares; Kenneth P Seier; Ritika Kundra; Mithat Gönen; Paul J Shin; Thomas Boerner; Carlie Sigel; Ramyasree Madupuri; Efsevia Vakiani; Andrea Cercek; James J Harding; Nancy E Kemeny; Louise C Connell; Vinod P Balachandran; Michael I D'Angelica; Jeffrey A Drebin; T Peter Kingham; Alice C Wei; William R Jarnagin Journal: Clin Cancer Res Date: 2021-05-07 Impact factor: 12.531