Defining the Risk of Early Recurrence Following Curative-Intent Resection for Distal Cholangiocarcinoma

Kota Sahara, Diamantis I. Tsilimigras, Junya Toyoda, Kentaro Miyake, Cecilia G. Ethun, Shishir K. Maithel, Daniel E. Abbott, George A. Poultsides, Ioannis Hatzaras, Ryan C. Fields, Matthew Weiss, Charles Scoggins, Chelsea A. Isom, Kamran Idrees, Perry Shen, Yasuhiro Yabushita, Ryusei Matsuyama, Itaru Endo, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Although multidisciplinary treatments including the use of adjuvant therapy (AT) have been adopted for biliary tract cancers, patients with distal cholangiocarcinoma (DCC) can still experience recurrence. We sought to characterize the incidence and predictors of early recurrence (ER) that occurred within 12 months following surgery for DCC. Patients and Methods: Patients who underwent resection for DCC between 2000 and 2015 were identified from the US multi-institutional database. Cox regression analysis was used to identify clinicopathological factors to develop an ER risk score, and the predictive model was validated in an external dataset. Results: Among 245 patients included in the analysis, 67 patients (27.3%) developed ER. No difference was noted in ER rates between patients who did and did not receive AT (28.7% vs. 25.0%, p = 0.55). Multivariable analysis revealed that neutrophil-to-lymphocyte ratio (NLR), peak total bilirubin (T-Bil), major vascular resection (MVR), lymphovascular invasion, and R1 surgical margin status were associated with a higher ER risk. A DIstal Cholangiocarcinoma Early Recurrence Score was developed according to each factor available prior to surgery [NLR > 9.0 (2 points); peak T-bil > 1.5 mg/dL (1 points); MVR (2 points)]. Cumulative ER rates incrementally increased among patients who were low (0 points; 10.6%), intermediate (1–2 points; 26.8%), or high (3–5 points; 57.6%) risk (p < 0.001) in the training dataset, as well as in the validation dataset [low (0 points); 3.4%, intermediate (1–2 points); 32.7%, or high risk (3–5 points); 55.6% (p < 0.001)]. Conclusions: Among patients undergoing resection for DCC, 1 in 4 patients experienced an ER. Alternative treatment strategies such as neoadjuvant chemotherapy may be considered especially among individuals deemed to be at high risk for ER.

Original languageEnglish
Pages (from-to)4205-4213
Number of pages9
JournalAnnals of Surgical Oncology
Issue number8
StatePublished - Aug 2021


Dive into the research topics of 'Defining the Risk of Early Recurrence Following Curative-Intent Resection for Distal Cholangiocarcinoma'. Together they form a unique fingerprint.

Cite this