Anatomic patterns of recurrence in biliary tract cancers: does primary tumor site matter?

Journal of Gastrointestinal Oncology

article

Andrew J. Sinnamon¹  Anthony C. Wood¹  Megan A. Satyadi²  Catherine V. Levitt²  Olivia Hardy²  Mintallah Haider¹  Richard D. Kim¹  Daniel A. Anaya¹  Jason W. Denbo¹ 

[1] Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute;University of South Florida Morsani College of Medicine

关键词: Recurrence;    anatomic;    biliary tract;    cholangiocarcinoma;    gallbladder;   

DOI  :  10.21037/jgo-21-868

学科分类：肿瘤学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: Recommendations for postoperative surveillance and adjuvant therapy following curative-intent resection for biliary tract cancers—including intrahepatic and extrahepatic cholangiocarcinoma (IHCCA and EHCCA) and primary gallbladder cancer (GBC)—are uniform across primary tumor site. However, these tumors may have distinct patterns of recurrence. Methods: A retrospective observational cohort study was performed at a specialty cancer center. Patients undergoing resection of IHCCA, EHCCA, and GBC were identified (2005–2020). Recurrence-free survival (RFS) was estimated using Kaplan-Meier and Cox proportional hazard methods. Anatomic patterns of initial site of recurrence were described and compared. Results: There were 142 patients included; 50 IHCCA, 32 EHCCA, and 60 GBC. Median RFS was 30.8 months, which was not significantly different between IHCCA, EHCCA, or GBC in univariate analysis or after adjustment. Nodal positivity was significantly associated with poor RFS (HR 3.92, P≤0.001). The most common initial site of recurrence overall was intrahepatic (n=49/64, 77%), in isolation (n=32) or synchronous with other site of recurrence (n=17). Significant differences in anatomic pattern of recurrence were observed (P=0.049) with IHCCAs more commonly recurring with simultaneous hepatic-pulmonary disease (n=5/22, 23%; EHCCA n=2/19, 10%; GBC n=1/23, 4%), GBC more commonly recurring within the porta (n=7/23, 30%; IHCCA n=0; EHCCA n=1/19, 5%), and EHCCA more commonly recurring within the peritoneum (n=5/19, 26%; IHCCA n=2/22, 9%, GBC n=2/23, 9%). Conclusions: Patterns of initial recurrence appear to differ between primary tumor site, likely reflecting underlying differences in anatomy and biology. These data could help inform future studies for adjuvant therapy as well as timing and anatomic focus for surveillance imaging.

【 授权许可】

Unknown