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High‐grade dysplasia/carcinoma in situ of the bile duct margin in patients with surgically resected node‐negative perihilar cholangiocarcinoma is associated with poor survival: a retrospective study
Author(s) -
Higuchi Ryota,
Yazawa Takehisa,
Uemura Shuichiro,
Izumo Wataru,
Furukawa Toru,
Yamamoto Masakazu
Publication year - 2017
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.481
Subject(s) - medicine , hazard ratio , retrospective cohort study , resection margin , dysplasia , surgical margin , bile duct , proportional hazards model , carcinoma , stage (stratigraphy) , metastasis , carcinoma in situ , lymph node , surgery , gastroenterology , cancer , resection , confidence interval , paleontology , biology
Background The clinical relevance of a high‐grade dysplasia/carcinoma in situ ( HD / CIS )‐positive bile duct margin in perihilar cholangiocarcinoma ( PHC ) is unclear. We evaluated the surgical outcomes of PHC patients with HD / CIS . Methods Clinicopathological data of 163 consecutive patients who underwent resection of PHC between 2004 and 2013 were analyzed retrospectively. Results Postoperative states included curative resection (R0) with free margins in 113 patients, non‐curative resection with HD / CIS (R1‐ HD / CIS ) in 22 patients, and non‐curative resection with any invasive carcinoma margin in 28 patients. Multivariate analyses in the entire cohort showed that lymph node metastasis (hazard ratio [ HR ] 1.91), distant metastasis ( HR 3.87), and non‐curative resection with any invasive carcinoma margin (vs. R0; HR 2.06) were significant independent prognosticators. However, in node‐negative and distant metastasis‐negative PHC patients, histology ( HR 2.97), R1‐ HD / CIS (vs. R0; HR 2.31), and non‐curative resection with any invasive carcinoma margin (vs. R0; HR 5.33) were significant independent prognosticators. The 2‐ and 5‐year disease‐specific survival rates in node‐negative and distant metastasis‐negative PHC patients with R1‐ HD / CIS margins were lower compared with those in patients with R0 margins (2‐year, 76.7% vs. 84.3%; 5‐year, 37.5% vs. 69.3%; P = 0.026). Conclusions R1‐ HD / CIS should be avoided in patients undergoing surgery for node‐negative and distant metastasis‐negative PHC .