Higher Tumor Burden Status Dictates the Impact of Surgical Margin Status on Overall Survival in Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma
Background The present study aimed to examine the prognostic significance of margin status following hepatectomy of intrahepatic cholangiocarcinoma (ICC) relative to overall tumor burden and nodal status. Method Patients who underwent curative-intent surgery for ICC between 1990 and 2017 were includ...
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| Veröffentlicht in: | Annals of surgical oncology 2023-04, Vol.30 (4), p.2023-2032 |
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| creator | Endo, Yutaka Sasaki, Kazunari Moazzam, Zorays Lima, Henrique A. Alaimo, Laura Guglielmi, Alfredo Aldrighetti, Luca Weiss, Matthew Bauer, Todd W. Alexandrescu, Sorin Poultsides, George A. Kitago, Minoru Maithel, Shishir K. Marques, Hugo P. Martel, Guillaume Pulitano, Carlo Shen, Feng Cauchy, François Koerkamp, Bas Groot Endo, Itaru Pawlik, Timothy M. |
| description | Background
The present study aimed to examine the prognostic significance of margin status following hepatectomy of intrahepatic cholangiocarcinoma (ICC) relative to overall tumor burden and nodal status.
Method
Patients who underwent curative-intent surgery for ICC between 1990 and 2017 were included from a multi-institutional database. The impact of margin status and width on overall survival (OS) was examined relative to TBS and preoperative nodal status.
Results
Among 1105 patients with ICC who underwent resection, median tumor burden score (TBS) was 6.1 (IQR 4.2–8.8) and 218 (19.7%) patients had N1 disease. More than one in eight patients had an R1 surgical margin (
n
= 154, 13.9%). Among patients with low or medium TBS, an increasing margin width was associated with an incrementally improved 5-year OS (R1 31.9% vs. 1–3 mm 38.5% vs. 3–10 mm 48.0% vs. ≥ 10 mm 52.3%). In contrast, among patients with a high TBS, margin width was not associated with better survival (R1 28.9% vs. 1–3 mm 22.8% vs. 3–10 mm 29.6% vs. ≥ 10 mm 13.7%). In addition, surgical margin status did not impact survival with cutoffs of TBS 7 or greater. Furthermore, patients with low or medium TBS and preoperative negative lymph nodes derived a survival benefit from an R0 resection (R1 resection, HR 2.15, 95% CI 1.35–3.44,
p
= 0.001). In contrast, margin status was not associated with prognosis among patients with a high TBS and preoperative positive/suspicious lymph nodes (R1 resection, HR 1.34, 95% CI 0.58–3.11,
p
= 0.50).
Conclusion
R0 resection and wider margin resection resulted in improved outcomes in patients with low tumor burden; however, the survival benefit of negative margin status disappeared in patients with underlying poor tumor biology. |
| doi_str_mv | 10.1245/s10434-022-12803-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2738195320</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2738195320</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-97c18fb0b4cadc08f671ecdc32645823a695bf272695c2c329a651d7f7588d893</originalsourceid><addsrcrecordid>eNp9kctuFDEQRS0EIiHwAyyQJTZsGvxoP3oJEyAjBQWRZG153O4eR932YLtH4m_4VGqYECQWrOqq6tStki5CLyl5S1kr3hVKWt42hLGGMk14ox6hUyqg1UpNH4MmUjcdk-IEPSvljhCqOBFP0QmXvJNa6lP08yKMW5_xzTKnjD8sufcRX1dbl4LPgwPhC65bj9fzzrqK04CvlzwGZyf8xYJ4oFPEV3uf7TQdiH3YAwHTr7YGH2vBt7H3eUwhjvibL97VABtgt441263fAefwapsmG8eQnM0uxDTb5-jJYKfiX9zXM3T76ePN6qK5vPq8Xr2_bBxXojadclQPG7Jpne0d0YNU1LvecSZboRm3shObgSkG1TFod1YK2qtBCa173fEz9Obou8vp--JLNXMozk_wjk9LMUxxTTvBGQH09T_oXVpyhO-A0lpoydXBkB0pl1Mp2Q9ml8Ns8w9DiTnkZ475GcjP_M7PKFh6dW-9bGbfP6z8CQwAfgQKjOLo89_b_7H9BQHmp9c</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2788586379</pqid></control><display><type>article</type><title>Higher Tumor Burden Status Dictates the Impact of Surgical Margin Status on Overall Survival in Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Endo, Yutaka ; Sasaki, Kazunari ; Moazzam, Zorays ; Lima, Henrique A. ; Alaimo, Laura ; Guglielmi, Alfredo ; Aldrighetti, Luca ; Weiss, Matthew ; Bauer, Todd W. ; Alexandrescu, Sorin ; Poultsides, George A. ; Kitago, Minoru ; Maithel, Shishir K. ; Marques, Hugo P. ; Martel, Guillaume ; Pulitano, Carlo ; Shen, Feng ; Cauchy, François ; Koerkamp, Bas Groot ; Endo, Itaru ; Pawlik, Timothy M.</creator><creatorcontrib>Endo, Yutaka ; Sasaki, Kazunari ; Moazzam, Zorays ; Lima, Henrique A. ; Alaimo, Laura ; Guglielmi, Alfredo ; Aldrighetti, Luca ; Weiss, Matthew ; Bauer, Todd W. ; Alexandrescu, Sorin ; Poultsides, George A. ; Kitago, Minoru ; Maithel, Shishir K. ; Marques, Hugo P. ; Martel, Guillaume ; Pulitano, Carlo ; Shen, Feng ; Cauchy, François ; Koerkamp, Bas Groot ; Endo, Itaru ; Pawlik, Timothy M.</creatorcontrib><description>Background
The present study aimed to examine the prognostic significance of margin status following hepatectomy of intrahepatic cholangiocarcinoma (ICC) relative to overall tumor burden and nodal status.
Method
Patients who underwent curative-intent surgery for ICC between 1990 and 2017 were included from a multi-institutional database. The impact of margin status and width on overall survival (OS) was examined relative to TBS and preoperative nodal status.
Results
Among 1105 patients with ICC who underwent resection, median tumor burden score (TBS) was 6.1 (IQR 4.2–8.8) and 218 (19.7%) patients had N1 disease. More than one in eight patients had an R1 surgical margin (
n
= 154, 13.9%). Among patients with low or medium TBS, an increasing margin width was associated with an incrementally improved 5-year OS (R1 31.9% vs. 1–3 mm 38.5% vs. 3–10 mm 48.0% vs. ≥ 10 mm 52.3%). In contrast, among patients with a high TBS, margin width was not associated with better survival (R1 28.9% vs. 1–3 mm 22.8% vs. 3–10 mm 29.6% vs. ≥ 10 mm 13.7%). In addition, surgical margin status did not impact survival with cutoffs of TBS 7 or greater. Furthermore, patients with low or medium TBS and preoperative negative lymph nodes derived a survival benefit from an R0 resection (R1 resection, HR 2.15, 95% CI 1.35–3.44,
p
= 0.001). In contrast, margin status was not associated with prognosis among patients with a high TBS and preoperative positive/suspicious lymph nodes (R1 resection, HR 1.34, 95% CI 0.58–3.11,
p
= 0.50).
Conclusion
R0 resection and wider margin resection resulted in improved outcomes in patients with low tumor burden; however, the survival benefit of negative margin status disappeared in patients with underlying poor tumor biology.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-022-12803-7</identifier><identifier>PMID: 36396868</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Bile Duct Neoplasms - pathology ; Bile Ducts, Intrahepatic - pathology ; Cholangiocarcinoma ; Cholangiocarcinoma - pathology ; Hepatectomy ; Hepatobiliary Tumors ; Humans ; Lymph nodes ; Lymphatic system ; Margins of Excision ; Medical prognosis ; Medicine ; Medicine & Public Health ; Oncology ; Prognosis ; Retrospective Studies ; Surgery ; Surgical Oncology ; Survival ; Survival Rate ; Tumor Burden ; Tumors</subject><ispartof>Annals of surgical oncology, 2023-04, Vol.30 (4), p.2023-2032</ispartof><rights>Society of Surgical Oncology 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. Society of Surgical Oncology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-97c18fb0b4cadc08f671ecdc32645823a695bf272695c2c329a651d7f7588d893</citedby><cites>FETCH-LOGICAL-c375t-97c18fb0b4cadc08f671ecdc32645823a695bf272695c2c329a651d7f7588d893</cites><orcidid>0000-0002-7994-9870</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-022-12803-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-022-12803-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36396868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Endo, Yutaka</creatorcontrib><creatorcontrib>Sasaki, Kazunari</creatorcontrib><creatorcontrib>Moazzam, Zorays</creatorcontrib><creatorcontrib>Lima, Henrique A.</creatorcontrib><creatorcontrib>Alaimo, Laura</creatorcontrib><creatorcontrib>Guglielmi, Alfredo</creatorcontrib><creatorcontrib>Aldrighetti, Luca</creatorcontrib><creatorcontrib>Weiss, Matthew</creatorcontrib><creatorcontrib>Bauer, Todd W.</creatorcontrib><creatorcontrib>Alexandrescu, Sorin</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Kitago, Minoru</creatorcontrib><creatorcontrib>Maithel, Shishir K.</creatorcontrib><creatorcontrib>Marques, Hugo P.</creatorcontrib><creatorcontrib>Martel, Guillaume</creatorcontrib><creatorcontrib>Pulitano, Carlo</creatorcontrib><creatorcontrib>Shen, Feng</creatorcontrib><creatorcontrib>Cauchy, François</creatorcontrib><creatorcontrib>Koerkamp, Bas Groot</creatorcontrib><creatorcontrib>Endo, Itaru</creatorcontrib><creatorcontrib>Pawlik, Timothy M.</creatorcontrib><title>Higher Tumor Burden Status Dictates the Impact of Surgical Margin Status on Overall Survival in Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
The present study aimed to examine the prognostic significance of margin status following hepatectomy of intrahepatic cholangiocarcinoma (ICC) relative to overall tumor burden and nodal status.
Method
Patients who underwent curative-intent surgery for ICC between 1990 and 2017 were included from a multi-institutional database. The impact of margin status and width on overall survival (OS) was examined relative to TBS and preoperative nodal status.
Results
Among 1105 patients with ICC who underwent resection, median tumor burden score (TBS) was 6.1 (IQR 4.2–8.8) and 218 (19.7%) patients had N1 disease. More than one in eight patients had an R1 surgical margin (
n
= 154, 13.9%). Among patients with low or medium TBS, an increasing margin width was associated with an incrementally improved 5-year OS (R1 31.9% vs. 1–3 mm 38.5% vs. 3–10 mm 48.0% vs. ≥ 10 mm 52.3%). In contrast, among patients with a high TBS, margin width was not associated with better survival (R1 28.9% vs. 1–3 mm 22.8% vs. 3–10 mm 29.6% vs. ≥ 10 mm 13.7%). In addition, surgical margin status did not impact survival with cutoffs of TBS 7 or greater. Furthermore, patients with low or medium TBS and preoperative negative lymph nodes derived a survival benefit from an R0 resection (R1 resection, HR 2.15, 95% CI 1.35–3.44,
p
= 0.001). In contrast, margin status was not associated with prognosis among patients with a high TBS and preoperative positive/suspicious lymph nodes (R1 resection, HR 1.34, 95% CI 0.58–3.11,
p
= 0.50).
Conclusion
R0 resection and wider margin resection resulted in improved outcomes in patients with low tumor burden; however, the survival benefit of negative margin status disappeared in patients with underlying poor tumor biology.</description><subject>Bile Duct Neoplasms - pathology</subject><subject>Bile Ducts, Intrahepatic - pathology</subject><subject>Cholangiocarcinoma</subject><subject>Cholangiocarcinoma - pathology</subject><subject>Hepatectomy</subject><subject>Hepatobiliary Tumors</subject><subject>Humans</subject><subject>Lymph nodes</subject><subject>Lymphatic system</subject><subject>Margins of Excision</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Tumor Burden</subject><subject>Tumors</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctuFDEQRS0EIiHwAyyQJTZsGvxoP3oJEyAjBQWRZG153O4eR932YLtH4m_4VGqYECQWrOqq6tStki5CLyl5S1kr3hVKWt42hLGGMk14ox6hUyqg1UpNH4MmUjcdk-IEPSvljhCqOBFP0QmXvJNa6lP08yKMW5_xzTKnjD8sufcRX1dbl4LPgwPhC65bj9fzzrqK04CvlzwGZyf8xYJ4oFPEV3uf7TQdiH3YAwHTr7YGH2vBt7H3eUwhjvibL97VABtgt441263fAefwapsmG8eQnM0uxDTb5-jJYKfiX9zXM3T76ePN6qK5vPq8Xr2_bBxXojadclQPG7Jpne0d0YNU1LvecSZboRm3shObgSkG1TFod1YK2qtBCa173fEz9Obou8vp--JLNXMozk_wjk9LMUxxTTvBGQH09T_oXVpyhO-A0lpoydXBkB0pl1Mp2Q9ml8Ns8w9DiTnkZ475GcjP_M7PKFh6dW-9bGbfP6z8CQwAfgQKjOLo89_b_7H9BQHmp9c</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Endo, Yutaka</creator><creator>Sasaki, Kazunari</creator><creator>Moazzam, Zorays</creator><creator>Lima, Henrique A.</creator><creator>Alaimo, Laura</creator><creator>Guglielmi, Alfredo</creator><creator>Aldrighetti, Luca</creator><creator>Weiss, Matthew</creator><creator>Bauer, Todd W.</creator><creator>Alexandrescu, Sorin</creator><creator>Poultsides, George A.</creator><creator>Kitago, Minoru</creator><creator>Maithel, Shishir K.</creator><creator>Marques, Hugo P.</creator><creator>Martel, Guillaume</creator><creator>Pulitano, Carlo</creator><creator>Shen, Feng</creator><creator>Cauchy, François</creator><creator>Koerkamp, Bas Groot</creator><creator>Endo, Itaru</creator><creator>Pawlik, Timothy M.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7994-9870</orcidid></search><sort><creationdate>20230401</creationdate><title>Higher Tumor Burden Status Dictates the Impact of Surgical Margin Status on Overall Survival in Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma</title><author>Endo, Yutaka ; Sasaki, Kazunari ; Moazzam, Zorays ; Lima, Henrique A. ; Alaimo, Laura ; Guglielmi, Alfredo ; Aldrighetti, Luca ; Weiss, Matthew ; Bauer, Todd W. ; Alexandrescu, Sorin ; Poultsides, George A. ; Kitago, Minoru ; Maithel, Shishir K. ; Marques, Hugo P. ; Martel, Guillaume ; Pulitano, Carlo ; Shen, Feng ; Cauchy, François ; Koerkamp, Bas Groot ; Endo, Itaru ; Pawlik, Timothy M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-97c18fb0b4cadc08f671ecdc32645823a695bf272695c2c329a651d7f7588d893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Bile Duct Neoplasms - pathology</topic><topic>Bile Ducts, Intrahepatic - pathology</topic><topic>Cholangiocarcinoma</topic><topic>Cholangiocarcinoma - pathology</topic><topic>Hepatectomy</topic><topic>Hepatobiliary Tumors</topic><topic>Humans</topic><topic>Lymph nodes</topic><topic>Lymphatic system</topic><topic>Margins of Excision</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Tumor Burden</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Endo, Yutaka</creatorcontrib><creatorcontrib>Sasaki, Kazunari</creatorcontrib><creatorcontrib>Moazzam, Zorays</creatorcontrib><creatorcontrib>Lima, Henrique A.</creatorcontrib><creatorcontrib>Alaimo, Laura</creatorcontrib><creatorcontrib>Guglielmi, Alfredo</creatorcontrib><creatorcontrib>Aldrighetti, Luca</creatorcontrib><creatorcontrib>Weiss, Matthew</creatorcontrib><creatorcontrib>Bauer, Todd W.</creatorcontrib><creatorcontrib>Alexandrescu, Sorin</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Kitago, Minoru</creatorcontrib><creatorcontrib>Maithel, Shishir K.</creatorcontrib><creatorcontrib>Marques, Hugo P.</creatorcontrib><creatorcontrib>Martel, Guillaume</creatorcontrib><creatorcontrib>Pulitano, Carlo</creatorcontrib><creatorcontrib>Shen, Feng</creatorcontrib><creatorcontrib>Cauchy, François</creatorcontrib><creatorcontrib>Koerkamp, Bas Groot</creatorcontrib><creatorcontrib>Endo, Itaru</creatorcontrib><creatorcontrib>Pawlik, Timothy M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Endo, Yutaka</au><au>Sasaki, Kazunari</au><au>Moazzam, Zorays</au><au>Lima, Henrique A.</au><au>Alaimo, Laura</au><au>Guglielmi, Alfredo</au><au>Aldrighetti, Luca</au><au>Weiss, Matthew</au><au>Bauer, Todd W.</au><au>Alexandrescu, Sorin</au><au>Poultsides, George A.</au><au>Kitago, Minoru</au><au>Maithel, Shishir K.</au><au>Marques, Hugo P.</au><au>Martel, Guillaume</au><au>Pulitano, Carlo</au><au>Shen, Feng</au><au>Cauchy, François</au><au>Koerkamp, Bas Groot</au><au>Endo, Itaru</au><au>Pawlik, Timothy M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Higher Tumor Burden Status Dictates the Impact of Surgical Margin Status on Overall Survival in Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>30</volume><issue>4</issue><spage>2023</spage><epage>2032</epage><pages>2023-2032</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
The present study aimed to examine the prognostic significance of margin status following hepatectomy of intrahepatic cholangiocarcinoma (ICC) relative to overall tumor burden and nodal status.
Method
Patients who underwent curative-intent surgery for ICC between 1990 and 2017 were included from a multi-institutional database. The impact of margin status and width on overall survival (OS) was examined relative to TBS and preoperative nodal status.
Results
Among 1105 patients with ICC who underwent resection, median tumor burden score (TBS) was 6.1 (IQR 4.2–8.8) and 218 (19.7%) patients had N1 disease. More than one in eight patients had an R1 surgical margin (
n
= 154, 13.9%). Among patients with low or medium TBS, an increasing margin width was associated with an incrementally improved 5-year OS (R1 31.9% vs. 1–3 mm 38.5% vs. 3–10 mm 48.0% vs. ≥ 10 mm 52.3%). In contrast, among patients with a high TBS, margin width was not associated with better survival (R1 28.9% vs. 1–3 mm 22.8% vs. 3–10 mm 29.6% vs. ≥ 10 mm 13.7%). In addition, surgical margin status did not impact survival with cutoffs of TBS 7 or greater. Furthermore, patients with low or medium TBS and preoperative negative lymph nodes derived a survival benefit from an R0 resection (R1 resection, HR 2.15, 95% CI 1.35–3.44,
p
= 0.001). In contrast, margin status was not associated with prognosis among patients with a high TBS and preoperative positive/suspicious lymph nodes (R1 resection, HR 1.34, 95% CI 0.58–3.11,
p
= 0.50).
Conclusion
R0 resection and wider margin resection resulted in improved outcomes in patients with low tumor burden; however, the survival benefit of negative margin status disappeared in patients with underlying poor tumor biology.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36396868</pmid><doi>10.1245/s10434-022-12803-7</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-7994-9870</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2023-04, Vol.30 (4), p.2023-2032 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Bile Duct Neoplasms - pathology Bile Ducts, Intrahepatic - pathology Cholangiocarcinoma Cholangiocarcinoma - pathology Hepatectomy Hepatobiliary Tumors Humans Lymph nodes Lymphatic system Margins of Excision Medical prognosis Medicine Medicine & Public Health Oncology Prognosis Retrospective Studies Surgery Surgical Oncology Survival Survival Rate Tumor Burden Tumors |
| title | Higher Tumor Burden Status Dictates the Impact of Surgical Margin Status on Overall Survival in Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma |
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