Perineural Invasion in Extrahepatic Cholangiocarcinoma: Prognostic Impact and Treatment Strategies

• Published in: Journal of gastrointestinal surgery 2013-08, Vol.17 (8), p.1429-1439
• Main Authors: Murakami, Yoshiaki, Uemura, Kenichiro, Sudo, Takeshi, Hashimoto, Yasushi, Kondo, Naru, Nakagawa, Naoya, Muto, Takeshi, Sasaki, Hayato, Urabe, Kazuhide, Sueda, Taijiro
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bile Duct Neoplasms - drug therapy; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Bile ducts; Bile Ducts, Extrahepatic; Cancer therapies; Chemotherapy; Chemotherapy, Adjuvant; Cholangiocarcinoma; Cholangiocarcinoma - drug therapy; Cholangiocarcinoma - secondary; Cholangiocarcinoma - surgery; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Dissection; Drug Combinations; Endoscopy; Female; Gallbladder; Gastroenterology; Gemcitabine; Hepatectomy; Hepatectomy - adverse effects; Humans; Kaplan-Meier Estimate; Lymphatic Metastasis; Lymphatic system; Male; Medical prognosis; Medical records; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Staging; Neoplasm, Residual; Original Article; Oxonic Acid - administration & dosage; Pancreaticoduodenectomy; Peripheral Nerves - pathology; Proportional Hazards Models; Retrospective Studies; Surgery; Survival analysis; Survival Rate; Tegafur - administration & dosage; Treatment Outcome; Tumors
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-013-2251-0

Background The significance of perineural invasion in extrahepatic cholangiocarcinoma has not been fully elucidated. This study aims to determine the prognostic impact of and optimal treatment strategy for perineural invasion in patients with extrahepatic cholangiocarcinoma. Methods Medical records of 133 patients with extrahepatic cholangiocarcinoma who underwent curative resection were reviewed retrospectively. Ninety-eight patients had perineural invasion and 35 patients did not. Univariate and multivariate survival analyses were performed to clarify the prognostic impact of and optimal treatment strategy for perineural invasion. Results Only tumor differentiation ( P  = 0.024) was independently associated with perineural invasion in the multivariate logistic regression model. Multivariate survival analysis revealed that perineural invasion ( P  = 0.002), resection margin status ( P  = 0.016), and International Union Against Cancer (UICC) pT factor ( P  = 0.015) were independent prognostic factors of overall survival. Overall 5-year survival rates for patients with and without perineural invasion were 28 and 74 %, respectively. Among 98 patients with perineural invasion, the use of adjuvant chemotherapy ( P  = 0.003), lymph node status ( P  = 0.015), resection margin status ( P  = 0.008), and UICC pT factor ( P  = 0.016) were independently associated with overall survival by multivariate analysis. Overall 5-year survival rates for patients with perineural invasion who did and did not receive adjuvant chemotherapy were 33 and 21 %, respectively ( P  = 0.023). Conclusions Perineural invasion is a potent prognostic factor in extrahepatic cholangiocarcinoma. Adjuvant chemotherapy may improve the overall survival of patients with perineural invasion.