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Defining Early Recurrence of Hilar Cholangiocarcinoma After Curative-intent Surgery: A Multi-institutional Study from the US Extrahepatic Biliary Malignancy Consortium

Background Time to tumor recurrence may be associated with outcomes following resection of hepatobiliary cancers. The objective of the current study was to investigate risk factors and prognosis among patients with early versus late recurrence of hilar cholangiocarcinoma (HCCA) after curative-intent...

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Published in:World journal of surgery 2018-09, Vol.42 (9), p.2919-2929
Main Authors: Zhang, Xu-Feng, Beal, Eliza W., Chakedis, Jeffery, Chen, Qinyu, Lv, Yi, Ethun, Cecilia G., Salem, Ahmed, Weber, Sharon M., Tran, Thuy, Poultsides, George, Son, Andre Y., Hatzaras, Ioannis, Jin, Linda, Fields, Ryan C., Buettner, Stefan, Scoggins, Charles, Martin, Robert C. G., Isom, Chelsea A., Idrees, Kamron, Mogal, Harveshp D., Shen, Perry, Maithel, Shishir K., Schmidt, Carl R., Pawlik, Timothy M.
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Language:English
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Summary:Background Time to tumor recurrence may be associated with outcomes following resection of hepatobiliary cancers. The objective of the current study was to investigate risk factors and prognosis among patients with early versus late recurrence of hilar cholangiocarcinoma (HCCA) after curative-intent resection. Methods A total of 225 patients who underwent curative-intent resection for HCCA were identified from 10 academic centers in the USA. Data on clinicopathologic characteristics, pre-, intra-, and postoperative details and overall survival (OS) were analyzed. The slope of the curves identified by linear regression was used to categorize recurrences as early versus late. Results With a median follow-up of 18.0 months, 99 (44.0%) patients experienced a tumor recurrence. According to the slope of the curves identified by linear regression, the functions of the two straight lines were y  = −0.465 x  + 16.99 and y  = −0.12 x  + 7.16. The intercept value of the two lines was 28.5 months, and therefore, 30 months (2.5 years) was defined as the cutoff to differentiate early from late recurrence. Among 99 patients who experienced recurrence, the majority ( n  = 80, 80.8%) occurred within the first 2.5 years (early recurrence), while 19.2% of recurrences occurred beyond 2.5 years (late recurrence). Early recurrence was more likely present as distant disease (75.1% vs. 31.6%, p  = 0.001) and was associated with a worse OS (Median OS, early 21.5 vs. late 50.4 months, p  
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-018-4530-0