University of Wisconsin Hospital, Madison, WI
Amir A. Rahnemai-Azar , Sean Ronnekleiv-Kelly , Daniel Abbott , Cecilia Grace Ethun , George A. Poultsides , Thuy Tran , Ryan Fields , Bradley Aaron Krasnick , Robert C. G. Martin II, Charles Raben Scoggins , Kamran Idrees , Chelsea A Isom , Ioannis Hatzaras , Rivfka Shenoy , Perry Shen , James D. Perkins , Timothy M. Pawlik , Shishir K. Maithel , Sharon M. Weber
Background: Surgical resection is required for curative treatment of patients with extra-hepatic cholangiocarcinoma (EH-CCA). The objective of this study was to determine if the distance of surgical margin was associated with outcome. Methods: Patients who underwent curative-intent resection for EH-CCA between 2000 and 2015 at 10 hepatobiliary centers across the U.S. were evaluated using prospectively collected data. Cox proportional hazard model was utilized to evaluate the influence of the extent of the margin on outcome. Results: 538 patients with EH-CCA who underwent curative-intent resection were included: 383 (71%) undergoing R0 resection, 153 (28%) undergoing R1 resection, and 2 with R2 resection. A negative surgical margin (R0) was associated with improved recurrence-free (RFS) and overall survival (OS) (RFS: 10.5% vs. 3.6% (R1) and OS: 25.8% vs. 9.3% (R1). Subsequently, further analysis on 161 patients with complete data on distance of resection margin, all undergoing R0 resection, was performed to assess the impact of extent of margin on outcome. On multi-variable analysis, the resection margin distance, analyzed as a continuous variable, was not associated with either improved RFS (RR 1.00, 95% CI 0.96-1.05; p 0.71) or OS (RR 0.99, 95% CI 0.96-1.01; p 0.49). Increasing age, increased tumor size, and LN metastasis were identified as independent predictors of OS; while RFS were mainly dependent on tumor size and LN metastasis (Table). Conclusions: Achieving R0 resection is acceptable for EH-CCA tumors, and obtaining additional margin does not confer a benefit on overall survival. Increasing age, tumor size, and LN metastasis are independent predictors of RFS and OS, but increased margin width is not associated with improvement in either. Multivariable analysis of factors affecting OS of patients with extra-hepatic CCA who underwent surgical resection, with significant factors noted in bold.
Variable | RR | CI |
---|---|---|
Closest margin distance | 0.99 | 0.96- 1.01 |
Preoperative biopsy | 0.68 | 0.44- 1.06 |
Male gender | 1.40 | 0.92- 2.19 |
Lymphovascular invasion | 1.32 | 0.83- 2.12 |
Perineural invasion | 0.79 | 0.51- 1.28 |
Age | 1.03 | 1.01- 1.05 |
Tumor size | 1.02 | 1.00- 1.03 |
Lymph node positive | 1.87 | 1.21- 2.89 |
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2021 ASCO Annual Meeting
First Author: Malcolm MacKenzie
2023 ASCO Annual Meeting
First Author: Sameh Hany Emile
2024 ASCO Gastrointestinal Cancers Symposium
First Author: Munir Buhaya
2022 ASCO Gastrointestinal Cancers Symposium
First Author: Nuri Karadurmus