Background: Lymph node metastasis and positive resection margins have been reported to be major determinants of overall survival (OS) and poor recurrence-free survival (RFS) for patients who underwent resection for perihilar cholangiocarcinoma (pCCA). However, the prognostic value of positive lymph nodes independently from resection margin status on OS has not been evaluated. Methods: From the European Cholangiocarcinoma (ENSCCA) registry, patients who underwent resection for pCCA between 1994 and 2021 were included in this retrospective cohort study. The primary outcome was OS stratified for resection margin and lymph node status. The secondary outcome was recurrence-free survival. Results: A total of 325 patients from 11 different centers and six European countries were included. Of these, 194 (59.7%) patients had negative resection margins. In 113 (34.8%) patients, positive lymph nodes were found. Lymph node status, histological grade, and ECOG performance status were independent prognostic factors for survival. The median OS for N0R0, N0R1, N+R0, and N+R1 was 38, 30, 18, and 12 months, respectively (p < 0.001). Conclusion: These data indicate that in the presence of positive regional lymph nodes, resection margin status does not determine OS or RFS in patients with pCCA. Achieving negative margins in patients with positive nodes should not come at the expense of more extensive surgery and associated higher mortality.
|Publication status||Published - 12 May 2022|
Bibliographical noteFunding Information:
The ENSCCA Registry is completely funded by the European Association for the Study of the Liver (EASL; Registry grant awards 2016 and 2019 to J.M.B.), Incyte Bioscience International Sàrl (grant award 2020 to J.M.B.) and European Union’s Horizon 2020 Research and Innovation Program (grant number 825510, ESCALON: to J.M.B. and A.L.).Acknowledgments: The authors would like to thank the patients and their families for the participa-tion in this study, the “Asociación Española de Gastroenterología” (AEG) for the REDCap database license and training, and Ioana Riaño (Biodonostia Health Research Institute) for the support on the ethical aspects of the Registry. This article is based upon work from European Horizon 2020 COST Action CA18122 European Cholangiocarcinoma Network (Euro-Cholangio-Net), supported by COST (European Cooperation in Science and Technology: www.cost.eu (accessed on 9 May 2022), a funding agency for research and innovation networks), in collaboration with the European Network for the Study of Cholangiocarcinoma (ENSCCA: http://www.enscca.org/ (accessed on 9 May 2022)), the International Primary Sclerosing Cholangitis Study Group (iPSCSG: https://www.ipscsg.org/ (accessed on 9 May 2022)), the European Reference Network on Rare Liver Diseases (ERN-Rare Liver: https://rare-liver.eu/ (accessed on 9 May 2022)), and the European Reference Network on Rare Adult Cancers (solid tumors; EURACAN: https://euracan.eu/ (accessed on 9 May 2022)). Angela Lamarca received funding from the Christie Charity and the European Union’s Horizon 2020 Research and Innovation Program (grant number 825510, ESCALON). Alejandro Forner received grant support from the Instituto de Salud Carlos III (PI18/00542).
Funding: The ENSCCA Registry is completely funded by the European Association for the Study of the Liver (EASL; Registry grant awards 2016 and 2019 to J.M.B.), Incyte Bioscience International Sàrl (grant award 2020 to J.M.B.) and European Union’s Horizon 2020 Research and Innovation Program (grant number 825510, ESCALON: to J.M.B. and A.L.).
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