Radiat Oncol J.  2014 Jun;32(2):63-69. 10.3857/roj.2014.32.2.63.

Patterns of failure and prognostic factors in resected extrahepatic bile duct cancer: implication for adjuvant radiotherapy

• Koo TR
• Eom KY
• Kim IA
• Cho JY
• Yoon YS
• Hwang DW
• Han HS
• Kim JS

• KMID: 1842042
• DOI: http://doi.org/10.3857/roj.2014.32.2.63

Abstract

PURPOSE
To find the applicability of adjuvant radiotherapy for extrahepatic bile duct cancer (EBDC), we analyzed the pattern of failure and evaluate prognostic factors of locoregional failure after curative resection without adjuvant treatment.
MATERIALS AND METHODS
In 97 patients with resected EBDC, the location of tumor was classified as proximal (n = 26) and distal (n = 71), using the junction of the cystic duct and common hepatic duct as the dividing point. Locoregional failure sites were categorized as follows: the hepatoduodenal ligament and tumor bed, the celiac artery and superior mesenteric artery, and other sites.
RESULTS
The median follow-up time was 29 months for surviving patients. Three-year locoregional progression-free survival, progression-free survival, and overall survival rates were 50%, 42%, and 52%, respectively. Regarding initial failures, 79% and 81% were locoregional failures in proximal and distal EBDC patients, respectively. The most common site was the hepatoduodenal ligament and tumor bed. In the multivariate analysis, perineural invasion was associated with poor locoregional progression-free survival (p = 0.023) and progression-free survival (p = 0.012); and elevated postoperative CA19-9 (> or =37 U/mL) did with poor locoregional progression-free survival (p = 0.002), progression-free survival (p < 0.001) and overall survival (p < 0.001).
CONCLUSION
Both proximal and distal EBDC showed remarkable proportion of locoregional failure. Perineural invasion and elevated postoperative CA19-9 were risk factors of locoregional failure. In these patients with high risk of locoregional failure, adjuvant radiotherapy could be considered to improve locoregional control.

Keyword

Bile duct neoplasms; Prognosis; Recurrence; Survival analysis

MeSH Terms

Bile Duct Neoplasms
Bile Ducts, Extrahepatic*
Celiac Artery
Cystic Duct
Disease-Free Survival
Follow-Up Studies
Hepatic Duct, Common
Humans
Ligaments
Mesenteric Artery, Superior
Multivariate Analysis
Prognosis
Radiotherapy, Adjuvant*
Recurrence
Risk Factors
Survival Analysis
Survival Rate