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Abstract

BACKGROUND:

This study aimed to investigate post-recurrence overall survival (PROS) in patients with recurrent extrahepatic cholangiocarcinoma (EHC) and to indicate which groups of patients need active salvage treatments.

METHODS:

We retrospectively reviewed the records of 251 consecutive patients who underwent curative surgery followed by adjuvant chemoradiotherapy for EHC. Among these, 144 patients experienced a recurrence and were included for further analysis.

RESULTS:

The median PROS was 7 months (range, 1-130). In multivariate analysis, poorly differentiated histology, short disease-free survival, poor performance status, and elevated CA 19-9 were identified as significant prognosticators for poor PROS. Based on this, we stratified study patients into three categories by the number of risk factors: group 1 (0 or 1 factors), group 2 (2 factors) and group 3 (3-4 factors). Median PROS for groups 1, 2, and 3 were 13, 7, and 5 months, respectively (p < 0.001). Group 1 patients showed a significant benefit from salvage treatment, but groups 2 and 3 did not demonstrate clear benefit. In addition, we developed a nomogram to specifically identify individual patient's prognosis.

CONCLUSION:

Our simple risk stratification as well as proposed nomogram can classify patients into subgroups with different prognosis and will help facilitate personalized strategies after recurrence.​

Author information​

Kim BH1, Kim K2, Chie EK3, Kwon J4, Jang JY5, Kim SW5, Oh DY6, Bang YJ6.

1 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Division of Biological Warfare Preparedness and Response, Armed Forces Medical Research Institute, Daejeon, South Korea.

2 Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, South Korea. Electronic address: kyubokim.ro@gmail.com.

3 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea.

4 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Chungnam National University Hospital, Daejeon, South Korea.

5 Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.

6 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.