Dataset Information

Prognostic analysis of patients with combined hepatocellular-cholangiocarcinoma after radical resection: A retrospective multicenter cohort study.

ABSTRACT:

Background

Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a form of rare primary liver cancer that combines intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma.

Aim

To investigate overall survival (OS) and recurrence-free survival (RFS) after radical resection in patients with cHCC-CCA, and the clinicopathological factors affecting prognosis in two center hospitals of China.

Methods

We reviewed consecutive patients with cHCC-CCA who received radical resection between January 2005 and September 2021 at Peking Union Medical College and the 5th Medical Center of the PLA General Hospital retrospectively. Regular follow-up and clinicopathological characteristics were systematic collected for baseline and prognostic analysis.

Results

Our study included 95 patients who received radical resection. The majority of these patients were male and 82.7% of these patients were infected with HBV. The mean tumor size was 4.5 cm, and approximately 40% of patients had more than one lesion. The median OS was 26.8 (95%CI: 18.5-43.0) mo, and the median RFS was 7.27 (95%CI: 5.83-10.3) mo. Independent predictors of OS were CA19-9 ≥ 37 U/mL (HR = 8.68, P = 0.002), Child-Pugh score > 5 (HR = 5.52, P = 0.027), tumor number > 1 (HR = 30.85, P = 0.002), tumor size and transarterial chemoembolization (TACE) after surgery (HR = 0.2, P = 0.005).

Conclusion

The overall postoperative survival of cHCC-CCA patients is poor, and most patients experience relapse within a short period of time after surgery. Preoperative tumor biomarker (CA19-9, alpha-fetoprotein) levels, tumor size, and Child-Pugh score can significantly affect OS. Adjuvant TACE after surgery prolongs RFS, suggesting that TACE is a possible option for postoperative adjuvant therapy in patients with cHCC-CCA.

SUBMITTER: Zhang G

PROVIDER: S-EPMC9669829 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Publications

Prognostic analysis of patients with combined hepatocellular-cholangiocarcinoma after radical resection: A retrospective multicenter cohort study.

Zhang Ge G Chen Bo-Wen BW Yang Xiao-Bo XB Wang Huai-Yuan HY Yang Xu X Xie Fu-Cun FC Chen Xiang-Qi XQ Yu Ling-Xiang LX Shi Jie J Lu Yin-Ying YY Zhao Hai-Tao HT

World journal of gastroenterology 20221101 41

<h4>Background</h4>Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a form of rare primary liver cancer that combines intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma.<h4>Aim</h4>To investigate overall survival (OS) and recurrence-free survival (RFS) after radical resection in patients with cHCC-CCA, and the clinicopathological factors affecting prognosis in two center hospitals of China.<h4>Methods</h4>We reviewed consecutive patients with cHCC-CCA who received radical ...[more]

PMID: 36405111

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Project description:Background and aimsThe prognosis of intrahepatic cholangiocarcinoma (ICC) after radical resection is far from satisfactory; however, the clinical value of adjuvant therapy (AT) remains controversial. This multicenter study aimed to evaluate the clinical value of AT and identify potential patients who would be benefited from AT.MethodsData from ICC patients who underwent radical resection were retrospectively collected from 12 hepatobiliary centers in China between December 2012 and December 2015. Patients were divided into AT and non-AT groups based on whether AT was administered or not. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method before and after 1:2 propensity score matching (PSM). Subgroup analyses were conducted based on the established staging systems.ResultsA total of 412 patients were enrolled in this study, and 77 patients (18.9%) received AT, including 32 (7.8%) patients who received transarterial chemoembolization (TACE), 21 (5.1%) patients who received chemotherapy, 10 (2.4%) patients who received radiotherapy, and 14 (3.4%) patients who received adjuvant chemoradiotherapy. The median OS and DFS were both longer in the AT group than in the non-AT group (43.0 months vs 21.0 months, P = .015; 16.0 months vs 11.0 months, P = .045, respectively), and the advantage of AT was confirmed for both the OS and DFS (P = .023; P = .046, respectively) after 1:2 PSM. Furthermore, based on the established nomogram, only "middle-risk" patients receiving AT cherished a longer median OS (43.0 months vs 20.0 months, P = .033). In subgroup analyses that were stratified by different AT strategies, patients receiving postoperative chemotherapy had a longer median OS (37.0 months vs 21.0 months, P = .039), while patients receiving postoperative TACE had a longer median DFS (50.0 months vs 11.0 months, P = .007).ConclusionWith the current data, we conclude that AT benefits ICC patients following radical resection, especially those "middle-risk" patients, as evaluated by the established nomogram. However, exactly which patients are the most suitable for AT requires further study and validation.

Project description:BackgroundThere is no clear consensus on the optimal systemic treatment regimen in combined hepatocellular-cholangiocarcinoma (cHCC-CCA) patients. We describe clinical characteristics and outcome of cHCC-CCA patients, with a special focus on patients receiving palliative systemic therapy, including immune checkpoint inhibitors (ICIs).MethodsIn this European retrospective, multicenter study, patients with histologically proven cHCC-CCA treated at four institutions between April 2003 and June 2022 were included. In patients receiving palliative systemic therapy, outcome was compared between cytotoxic chemotherapy (CHT)- and non-cytotoxic CHT (nCHT)-treated patients.ResultsOf 101 patients, the majority were male (n = 70, 69%) with a mean age of 64.6 ± 10.6 years. Only type of first-line treatment was independently associated with overall survival (OS). Palliative systemic therapy was administered to 44 (44%) patients. Of those, 25 (57%) patients received CHT and 19 (43%) had nCHT (n = 16 of them sorafenib) in systemic first line. Although there was no significant difference in overall response rate (ORR; CHT versus nCHT: 8% versus 5%), disease control rate (24% versus 21%), and median progression-free survival {3.0 months [95% confidence interval (CI) 1.4-4.6 months] versus 3.2 months (95% CI 2.8-3.6 months), P = 0.725}, there was a trend towards longer median OS in the CHT group [15.5 months (95% CI 8.0-23.0 months) versus 5.3 months (95% CI 0-12.5 months), P = 0.052]. However, in multivariable analysis, type of first-line regimen (CHT versus sorafenib) was not associated with OS. ORR in patients receiving ICIs (n = 7) was 29%.ConclusionsIn patients with cHCC-CCA, OS, progression-free survival, ORR, and disease control rate were not significantly different between individuals receiving CHT and patients receiving nCHT. Immunotherapy may be effective in a subset of patients. Prospective studies are needed to identify optimal systemic treatment regimens in cHCC-CCA.

Project description:BackgroundNowadays, the incidence of perihilar cholangiocarcinoma (PHCC) is increasing yearly, and biliary fistula is a common complication. However, there are few reports on the factors affecting the occurrence of biliary fistula. This study aimed to analyze the risk factors for the occurrence of biliary fistula after radical surgery for PHCC in elderly patients to provide a reference basis for improving the prognosis.MethodsFrom April 2016 to April 2021, we randomly included 250 elderly patients with pathologically diagnosed PHCC. Based on our established inclusion and exclusion criteria, we included 211 patients finally Bile drainage for 3 consecutive days after abdominal drainage or single bile drainage ≥100 mL/d was used as the diagnostic criteria for biliary fistula. Multiple logistic regression was used to analyze the independent risk factors for biliary fistula after radical surgery for PHCC. Besides, the Prognostic Score (PS), the Karnofsky performance score (KPS), and the quality of life (QOL) score were used to assess the patients' postoperative recovery, and survival curves were drawn to reflect their 1-year survival rate, using overall survival.ResultsThe statistical results showed a 36.5% incidence of biliary fistula. Our study showed that preoperative cholangitis, number of biliary anastomoses, etc. were independent risk factors for grade B and grade C biliary fistula. Besides, the presence of intraoperative hemorrhage (OR =0.223, P=0.006) and γ-glutamyl transpeptidase (γ-GT) on the first postoperative day (OR =1.011, P=0.013) were still independent risk factors for grade B biliary fistula, while C-reactive protein (CRP) (OR =1.026, P=0.011) and total bilirubin (TBil) (OR =0.003, P=1.066) on the first postoperative day and bile duct diameter (OR =0.299, P=0.020) were independent risk factors for grade C biliary fistula. Analysis of variance (ANOVA) showed statistically significant differences (P<0.05) between the three groups in terms of PS (P=0.000), KPS (P=0.001), and QOL scores (P=0.000).ConclusionsThe incidence of postoperative biliary fistula remains high in elderly patients treated with radical surgery for PHCC and seriously affects their prognosis. Therefore, focusing on the clinical characteristics and risk factors of patients, improving surgical precision and enhancing postoperative patient care to reduce the likelihood of postoperative biliary fistula, thereby prolonging patient life.

Project description:BackgroundThe occurrence of postoperative complications of distal cholangiocarcinoma (dCCA) is an indicator of poor patient prognosis. This study aimed to determine the immune-nutritional indexes (INIs) that can predict short-term postoperative complications.MethodsA retrospective analysis of 148 patients with dCCA who were operated radical pancreaticoduodenectomy at the First Hospital of Lanzhou University from December 2015 to March 2022 was conducted to assess the predictive value of preoperative INIs and preoperative laboratory tests for short-term postoperative complications, and a decision tree model was developed using classification and regression tree (CART) analysis to identify subgroups at risk for overall complications.ResultsIn this study, 83 patients (56.08%) experienced overall complications. Clavien-Dindo grade III-V complications occurred in 20 patients (13.51%), and 2 patients died. The areas under curves (AUCs) of the preoperative prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, and neutrophil-to-lymphocyte ratio (NLR) were compared; the PNI provided the maximum discrimination for complications (AUC = 0.685, 95% CI = 0.600-0.770), with an optimal cutoff value of 46.9, and the PNI ≤ 46.9 group had higher incidences of overall complications (70.67% vs. 40.00%, P < 0.001) and infectious complications (28.77% vs. 13.33%, P = 0.035). Multivariate logistic regression analysis identified PNI (OR = 0.87, 95% CI: 0.80-0.94) and total bilirubin (OR = 1.01, 95% CI: 1.00-1.01) were independent risk factors for overall complications (P < 0.05). According to CART analysis, PNI was the most important parameter, followed by the total bilirubin (TBIL) level. Patients with a PNI lower than the critical value and TBIL higher than the critical value had the highest overall complication rate (90.24%); the risk prediction model had an AUC of 0.714 (95% CI, 0.640-0.789) and could be used to stratify the risk of overall complications and predict grade I-II complications (P < 0.05).ConclusionThe preoperative PNI is a good predictor for short-term complications after the radical resection of dCCA. The decision tree model makes PNI and TBIL easier to use in clinical practice.

Dataset Information

Prognostic analysis of patients with combined hepatocellular-cholangiocarcinoma after radical resection: A retrospective multicenter cohort study.

Background

Aim

Methods

Results

Conclusion

Publications

Prognostic analysis of patients with combined hepatocellular-cholangiocarcinoma after radical resection: A retrospective multicenter cohort study.

Similar Datasets

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