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Review
, 97 (34), e11999

The Clinicopathological Factors Associated With Prognosis of Patients With Resectable Perihilar Cholangiocarcinoma: A Systematic Review and Meta-Analysis

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Review

The Clinicopathological Factors Associated With Prognosis of Patients With Resectable Perihilar Cholangiocarcinoma: A Systematic Review and Meta-Analysis

Zengwei Tang et al. Medicine (Baltimore).

Abstract

The refinement in surgical techniques combined with the preoperative management has improved the resectability rate of perihilar cholangiocarcinoma (pCCA). However, the prognosis of pCCA with curative resection is still dismal. This meta-analysis was performed to investigate the prognostic clinicopathological factors in resectable pCCA.PubMed, the Cochran Library, ScienceDirect, and Web of Science were searched systematically to identify reports focusing on studying the prognostic clinicopathological factors in resectable pCCA. The hazard ratios (HRs) and its 95% confidence interval (95%CI) from the identified studies using Cox proportional hazard regression model were extracted for overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) analysis.Three prospective and 35 retrospective cohort studies including 5681 resectable pCCA were included in the pooled analysis. Among more than 20 clinicopathological factors associated with negative survival of pCCA, only 6 were included in quantitative analysis which showed that lymph node involvement was associated with a reduced OS (HR = 2.04; 95%CI: 2.10-2.62), DSS (HR = 1.80; 95%CI: 1.39-2.34), DFS (HR = 4.38; 95%CI: 1.89-10.14), negative resection margin (HR = 2.04; 95%CI:1.73-2.41), operative transfusion (HR = 1.82; 95%CI: 1.06-3.11), and T3 or T4-stage (HR = 2.04; 95%CI: 2.04-2.53) were poor prognostic factors of OS, and poor or moderate differentiation was also an adverse prognostic factor of OS (HR = 2.71; 95%CI: 1.80-4.07) and DSS (HR = 1.74; 95%CI: 1.25-2.44). The overall median resectability rate (95CI%), R0 resection (95CI%), and 5-year OS (95CI%) in Eastern and Western countries were 74.9 (66.4-78.4) % and 41.3 (32.6-80.8) %, 70.7 (65.6-80.8) % and 75.9 (64.0-80.4) %, and 33.0 (29.7-39.7) % and 25.5 (20.0-31.6) %, respectively.Negative resection margin, lymph node involvement, poor or moderate differentiation grade was identified as the negative predictor factors of resectable pCCA. Operative transfusion and T3/T4 stage were also associated with a reduced survival of resectable pCCA.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Search flow diagram.
Figure 2
Figure 2
Forest plot for the pooled analysis the association of clinicopathological factors with overall survival of resectable perihilar cholangiocarcinoma. (A) Forest plot for the pooled analysis of surgical resection margins status. (B) Forest plot for the pooled analysis of lymph node status (positive vs negative). (C) Forest plot for the A pooled analysis of histological grade (poor or moderate vs well). (D) Forest plot for the pooled analysis of T-stage (T3 and/or T4 vs T1 and/or T2). (E) Forest plot for the pooled analysis of gender of participation (male vs female). (F) Forest plot for the pooled analysis of operative transfusion (yes vs no).
Figure 2 (Continued)
Figure 2 (Continued)
Forest plot for the pooled analysis the association of clinicopathological factors with overall survival of resectable perihilar cholangiocarcinoma. (A) Forest plot for the pooled analysis of surgical resection margins status. (B) Forest plot for the pooled analysis of lymph node status (positive vs negative). (C) Forest plot for the A pooled analysis of histological grade (poor or moderate vs well). (D) Forest plot for the pooled analysis of T-stage (T3 and/or T4 vs T1 and/or T2). (E) Forest plot for the pooled analysis of gender of participation (male vs female). (F) Forest plot for the pooled analysis of operative transfusion (yes vs no).
Figure 2 (Continued)
Figure 2 (Continued)
Forest plot for the pooled analysis the association of clinicopathological factors with overall survival of resectable perihilar cholangiocarcinoma. (A) Forest plot for the pooled analysis of surgical resection margins status. (B) Forest plot for the pooled analysis of lymph node status (positive vs negative). (C) Forest plot for the A pooled analysis of histological grade (poor or moderate vs well). (D) Forest plot for the pooled analysis of T-stage (T3 and/or T4 vs T1 and/or T2). (E) Forest plot for the pooled analysis of gender of participation (male vs female). (F) Forest plot for the pooled analysis of operative transfusion (yes vs no).
Figure 2 (Continued)
Figure 2 (Continued)
Forest plot for the pooled analysis the association of clinicopathological factors with overall survival of resectable perihilar cholangiocarcinoma. (A) Forest plot for the pooled analysis of surgical resection margins status. (B) Forest plot for the pooled analysis of lymph node status (positive vs negative). (C) Forest plot for the A pooled analysis of histological grade (poor or moderate vs well). (D) Forest plot for the pooled analysis of T-stage (T3 and/or T4 vs T1 and/or T2). (E) Forest plot for the pooled analysis of gender of participation (male vs female). (F) Forest plot for the pooled analysis of operative transfusion (yes vs no).
Figure 3
Figure 3
Forest plot for the pooled analysis the association of lymph node status (A) and histological grade (B) with DSS of resectable pCCA. DSS = disease-specific survival, pCCA = perihilar cholangiocarcinoma.
Figure 4
Figure 4
Forest plot for a pooled analysis of the association of lymph node status with disease-free survival.
Figure 5
Figure 5
Begg funnel plot for the pooled analysis of the prognostic role of surgical resection margins (A), lymph node status (B), and histological grade (C).
Figure 6
Figure 6
Sensitivity analysis of the results of pooled analysis of surgical resection margins (A), lymph node status (B), and histological grade (C).
Figure 7
Figure 7
The correlation between the age of resectable pCCA patients and 5-year OS rate (A), and the difference in resectablity rate (B), R0 resection (C), and 5-year OS (d) between Eastern and Western countries. OS = overall survival, pCCA = perihilar cholangiocarcinoma.

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References

    1. Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet 2014;383:2168–79. - PMC - PubMed
    1. Kimura N, Young AL, Toyoki Y, et al. Radical operation for hilar cholangiocarcinoma in comparable Eastern and Western centers: outcome analysis and prognostic factors. Surgery 2017;162:500–14. - PubMed
    1. Lee SG, Song GW, Hwang S, et al. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci 2010;17:476–89. - PubMed
    1. Li H, Qin Y, Cui Y, et al. Analysis of the surgical outcome and prognostic factors for hilar cholangiocarcinoma: a Chinese experience. Dig Surg 2011;28:226–31. - PubMed
    1. Cheng QB, Yi B, Wang JH, et al. Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth type III and IV. Eur J Surg Oncol 2012;38:1197–203. - PubMed

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