Radiographic features predictive of recurrence and survival after surgical resection of perihilar cholangiocarcinoma

Julaluck Promsorn; Panjaporn Naknan; Aumkhae Sookprasert; Kosin Wirasorn; Jarin Chindaprasirt; Attapol Titapun; Piyapharom Intarawichian; Mukesh Harisinghani

doi:10.1016/j.heliyon.2024.e28805

Radiographic features predictive of recurrence and survival after surgical resection of perihilar cholangiocarcinoma

Heliyon. 2024 Mar 29;10(7):e28805. doi: 10.1016/j.heliyon.2024.e28805. eCollection 2024 Apr 15.

Authors

Julaluck Promsorn¹, Panjaporn Naknan¹, Aumkhae Sookprasert², Kosin Wirasorn², Jarin Chindaprasirt², Attapol Titapun³, Piyapharom Intarawichian⁴, Mukesh Harisinghani⁵

Affiliations

¹ Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
² Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
³ Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
⁴ Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
⁵ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.

Abstract

Objective: To study which radiographic features were associated with recurrence and adverse outcome in patients undergoing surgical resection of perihilar cholangiocarcinoma (PCCA), as well as to evaluate the imaging patterns that signify recurrence after the resection of PCCA.

Materials and methods: This study was conducted in a solitary tertiary center and utilized a retrospective, analytical, case-control design. The study population consisted of patients with pathologically confirmed PCCA who underwent surgical resection and were subsequently followed up from January 2009 to December 2017. A total of 77 patients were enrolled in the study and were categorized into two distinct groups, namely recurrent and non-recurrent. The analysis encompassed the examination of demographic data and recurrence patterns. Additionally, survival and multivariate analyses were employed to assess radiographic imaging data and surgical information.

Results: Seventy-seven patients diagnosed with PCCA based on pathological evidence were included in the study. Among the participants, there were 28 females and 49 males, with ages ranging from 41 to 81 years (mean age of 60.65 ± 7.66). A noteworthy finding was the recurrence rate of 65 % observed following surgical resection. The presence of regional lymph node (LN) metastasis, adjacent organ invasion, and surgical margin emerged as the three independent factors that exhibited a significant association with recurrence after post-operative resection (p = 0.023, p = 0.028, and p = 0.010, respectively). The patients with PCCA who experienced regional LN metastasis had a median overall survival (OS) of 22 months, which was significantly lower than the 46 months observed in those without regional LN metastasis (p < 0.018). Furthermore, the individuals with regional LN metastasis had a death rate that was 2.08 times higher than those without (p = 0.040). In addition, those with adjacent organ invasion had an OS duration of 21 months compared with 52 months in those without (p = 0.008), and the rate of death was 2.39 times higher (p = 0.018). Patients with an R1 resection margin had an OS duration of 36 months compared with 51.56 months in those with an R0 resection margin (p = 0.006), as well as a 2.13 times higher rate of recurrence (p = 0.010) and a 2.43 times higher mortality rate (p = 0.013).

Conclusion: The presence of regional LN metastasis, invasion of adjacent organs, and R1 resection margin were identified as distinct factors that are linked to both disease recurrence and reduced OS. Local recurrence, as well as the spread of cancer to distant organs such as the lungs and liver, were frequently observed patterns of recurrence. To enhance the precision of staging, prognosis, and treatment, the inclusion of periductal fat or invasion of adjacent organs should be considered in the staging system for PCCA.

Keywords: Biliary tumor; Overall survival; Perihilar cholangiocarcinoma (PCCA); Prognostic factors; Recurrence; Recurrence patterns; Recurrence-free survival; Surgery.