COMPARISON OF SHORT- AND LONG-TERM OUTCOMES BETWEEN ANATOMICAL SUBTYPES OF RESECTED BILIARY TRACT CANCER IN A WESTERN HIGH-VOLUME CENTER
Eva Roos, Marin Strijker*, Lotte C. Franken, Olivier R. Busch, Jeanin E. Van Hooft, Heinz-Josef Klümpen, Hanneke van Laarhoven, Johanna Wilmink, Joanne Verheij, Thomas M. van Gulik, Marc Besselink
Amsterdam UMC, Amsterdam, Netherlands
Background: In studies on long-term outcome and prognosis of resected biliary tract cancer (BTC), outcomes for the different anatomical subtypes - intrahepatic, perihilar and distal cholangiocarcinoma (ICC, PHC, DCC) and gallbladder carcinoma (GBC) - are often combined. However, variations in histopathological parameters and long-term outcome are unclear, hampering interpretation of combined outcomes. Therefore, the aim was to compare clinicopathological characteristics and outcomes between the anatomical subtypes of BTC in a Western high-volume center.
Methods: All patients who underwent resection for pathology proven ICC, PHC, DCC or GBC (2000-2016) were retrospectively selected from a prospectively maintained database. Clinicopathological characteristics and outcomes were compared between the four subtypes of BTC.
Results: Overall, 361 patients with resected BTC were included (33 ICC, 135 PHC, 148 DCC, 45 GBC). High tumor stage (III-IV) was found in 33%, 29%, 55% and 11% of patients with ICC, PHC, DCC and GBC (p<0.001). Perineural growth and angioinvasion were seen in 68% and 26%, 91% and 48%, 89% and 62%, and 68% and 48% of ICC, PHC, DCC and GBC, respectively (both p<0.001). In 27%, 33%, 41% and 18% (ICC, PHC, DCC, GBC) R1 resection was found (p=0.013). Morbidity was 58%, 66%, 60%, 20% (p <0.001), mortality 9%, 15%, 3%, 4% (p<0.001), and median overall survival 37, 42, 29 and 41 months (p=0.147), for ICC, PHC, DCC, GBC, respectively. ECOG performance score and residual disease were independent prognostic factors for overall survival, anatomical subtype was not.
Conclusion: Short-term outcomes vary between subtypes of BTC and some diversity in pathological outcomes between anatomical subtypes of BTC exist. However, a significant difference in overall survival was not detected and anatomical subtype was not an independent prognostic factor. This data support the concept that BTC should be a regarded as a diverse group of closely related tumors and highlights the need for molecular data on BTC in order to improve classification.
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