Safety and efficacy of neoadjuvant chemotherapy based on our resectability criteria for locally advanced perihilar cholangiocarcinoma.
Gemcitabine
Neoadjuvant chemotherapy
Perihilar cholangiocarcinoma
Resectability
Upfront surgery
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
01 Jul 2023
01 Jul 2023
Historique:
received:
18
01
2023
accepted:
24
06
2023
medline:
3
7
2023
pubmed:
1
7
2023
entrez:
1
7
2023
Statut:
epublish
Résumé
Neoadjuvant chemotherapy (NAC) is not commonly used for perihilar cholangiocarcinoma (PHC). This study evaluated the safety and efficacy of NAC for PHC. Ninety-one PHC patients without metastases were treated at our department. Patients were classified as resectable (R), borderline resectable (BR), or locally advanced unresectable (LA). Upfront surgery (US) was performed for R-PHC patients without regional lymph node metastases (LNM) or those unable to tolerate NAC. The NAC regimen comprised two courses of gemcitabine-based chemotherapy for advanced PHC: R-PHC with LNM, BR, and LA. US and NAC were performed on 32 and 59 patients, respectively. For US, 31 patients underwent curative intent surgery (upfront-CIS). NAC caused adverse effects in 10/59 (17%), allowed 36/59 (61%) to undergo curative intent surgery (NAC-CIS) without impairing liver function, and spared 23/59 (39%) from undergoing resection (NAC-UR). Overall survival was better in the upfront-CIS and NAC-CIS groups than in the NAC-UR group (MST: 74 vs 57 vs 17 months, p < 0.001). In 59 NAC patients, tumour size response occurred in 11/11 (100%) of R, 22/33 (66.7%) of BR, and 9/15 (60.0%) of LA patients. The un-resection rate was the highest in the LA group (27% [3/11] than in R, 30% [10/33] in BR, and 67% [10/15] in LA, p = 0.039). Multivariate analyses revealed that LA and age were independent risk factors for non-resection after NAC. was safe and contributed to improving survival in advanced PHC patients. R-PHC was responsive to NAC, but LA remains a risk factor for non-resection through NAC.
Identifiants
pubmed: 37392289
doi: 10.1007/s00423-023-03000-5
pii: 10.1007/s00423-023-03000-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
261Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Mueller M, Breuer E, Mizuno T et al (2021) Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers. Ann Surg 274:780–788. https://doi.org/10.1097/SLA.0000000000005103
doi: 10.1097/SLA.0000000000005103
pubmed: 34334638
Mizuno T, Ebata T, Yokoyama Y et al (2022) Combined Vascular Resection for Locally Advanced Perihilar Cholangiocarcinoma. Ann Surg 275:382–390. https://doi.org/10.1097/SLA.0000000000004322
doi: 10.1097/SLA.0000000000004322
pubmed: 32976284
Nagino M (2012) Perihilar cholangiocarcinoma: a surgeon’s viewpoint on current topics. J Gastroenterol 47:1165–1176. https://doi.org/10.1007/s00535-012-0628-6
doi: 10.1007/s00535-012-0628-6
pubmed: 22847554
Di Benedetto F, Magistri P, Di Sandro S (2022) Perihilar-cholangiocarcinoma: what really matters? Hepatobiliary Surg Nutr 11:616–619. https://doi.org/10.21037/hbsn-22-225
doi: 10.21037/hbsn-22-225
pubmed: 36016744
pmcid: 9396081
Valle JW, Lamarca A, Goyal L, Barriuso J, Zhu AX (2017) New horizons for precision medicine in biliary tract cancers. Cancer Discov 7:943–962. https://doi.org/10.1158/2159-8290.CD-17-0245
doi: 10.1158/2159-8290.CD-17-0245
pubmed: 28818953
pmcid: 5586506
Watanabe N, Mizuno T, Yamaguchi J et al (2022) A proposal of drain removal criteria in hepatobiliary resection. J Hepatobiliary Pancreat Sci 29:974–982. https://doi.org/10.1002/jhbp.1194
doi: 10.1002/jhbp.1194
pubmed: 35666607
Cillo U, Fondevila C, Donadon M et al (2019) Surgery for cholangiocarcinoma. Liver Int 39:143–155. https://doi.org/10.1111/liv.14089
doi: 10.1111/liv.14089
pubmed: 30843343
pmcid: 6563077
Kuriyama N, Komatsubara H, Nakagawa Y et al (2021) Impact of combined vascular resection and reconstruction in patients with advanced perihilar cholangiocarcinoma. J Gastrointest Surg 25:3108–3118. https://doi.org/10.1007/s11605-021-05004-2
doi: 10.1007/s11605-021-05004-2
pubmed: 33884578
Yadav S, Xie H, Bin-Riaz I et al (2019) Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma: A propensity score matched analysis. Eur J Surg Oncol 45:1432–1438. https://doi.org/10.1016/j.ejso.2019.03.023
doi: 10.1016/j.ejso.2019.03.023
pubmed: 30914290
Kuriyama N, Usui M, Gyoten K, et al (2020) Neoadjuvant chemotherapy followed by curative-intent surgery for perihilar cholangiocarcinoma based on its anatomical resectability classification and lymph node status. BMC Cancer 20. https://doi.org/10.1186/s12885-020-06895-1
Kato A, Shimizu H, Ohtsuka M et al (2013) Surgical resection after downsizing chemotherapy for initially unresectable locally advanced biliary tract cancer: a retrospective single-center study. Ann Surg Oncol 20:318–324. https://doi.org/10.1245/s10434-012-2312-8
doi: 10.1245/s10434-012-2312-8
pubmed: 23149849
Yokoyama Y, Nishio H, Ebata T, Igami T, Sugawara G, Nagino M (2010) Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer. Br J Surg 97:1260–1268. https://doi.org/10.1002/bjs.7084
doi: 10.1002/bjs.7084
pubmed: 20602507
Sumiyoshi T, Shima Y, Okabayashi T et al (2016) Liver function assessment using 99mTc-GSA single-photon emission computed tomography (SPECT)/CT fusion imaging in hilar bile duct cancer: A retrospective study. Surgery 160:118–126. https://doi.org/10.1016/j.surg.2016.02.009
doi: 10.1016/j.surg.2016.02.009
pubmed: 27059635
Iwasaki M, Takada Y, Hayashi M et al (2004) Noninvasive evaluation of graft steatosis in living donor liver transplantation. Transplantation 78:1501–1505. https://doi.org/10.1097/01.tp.0000140499.23683.0d
doi: 10.1097/01.tp.0000140499.23683.0d
pubmed: 15599315
Miyazaki M, Kimura F, Shimizu H et al (2008) Extensive hilar bile duct resection using a transhepatic approach for patients with hepatic hilar bile duct diseases. Am J Surg 196:125–129. https://doi.org/10.1016/j.amjsurg.2007.04.020
doi: 10.1016/j.amjsurg.2007.04.020
pubmed: 18466867
Rizvi S, Khan SA, Hallemeier CL, Kelley RK, Gores GJ (2018) Cholangiocarcinoma - evolving concepts and therapeutic strategies. Nat Rev Clin Oncol 15:95–111. https://doi.org/10.1038/nrclinonc.2017.157
doi: 10.1038/nrclinonc.2017.157
pubmed: 28994423
DeOliveira ML, Cunningham SC, Cameron JL et al (2007) Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 245:755–762. https://doi.org/10.1097/01.sla.0000251366.62632.d3
doi: 10.1097/01.sla.0000251366.62632.d3
pubmed: 17457168
pmcid: 1877058
Mizuno T, Ebata T, Yokoyama Y et al (2017) Adjuvant gemcitabine monotherapy for resectable perihilar cholangiocarcinoma with lymph node involvement: a propensity score matching analysis. Surg Today 47:182–192. https://doi.org/10.1007/s00595-016-1354-0
doi: 10.1007/s00595-016-1354-0
pubmed: 27194019
Kitagawa Y, Nagino M, Kamiya J et al (2001) Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg 233:385–392. https://doi.org/10.1097/00000658-200103000-00013
doi: 10.1097/00000658-200103000-00013
pubmed: 11224627
pmcid: 1421255
Komaya K, Ebata T, Yokoyama Y et al (2018) Recurrence after curative-intent resection of perihilar cholangiocarcinoma: analysis of a large cohort with a close postoperative follow-up approach. Surgery 163:732–738. https://doi.org/10.1016/j.surg.2017.08.011
doi: 10.1016/j.surg.2017.08.011
pubmed: 29336813
Takahashi D, Mizuno T, Yokoyama Y et al (2021) Adjuvant S-1 vs gemcitabine for node-positive perihilar cholangiocarcinoma: A propensity score-adjusted analysis. J Hepatobiliary Pancreat Sci 28:716–726. https://doi.org/10.1002/jhbp.1005
doi: 10.1002/jhbp.1005
pubmed: 34087061
Jung F, Lee M, Doshi S et al (2021) Neoadjuvant therapy versus direct to surgery for T4 colon cancer: meta-analysis. Br J Surg 109:30–36. https://doi.org/10.1093/bjs/znab382
doi: 10.1093/bjs/znab382
pubmed: 34921604
van Dam JL, Janssen QP, Besselink MG et al (2022) Neoadjuvant therapy or upfront surgery for resectable and borderline resectable pancreatic cancer: A meta-analysis of randomised controlled trials. Eur J Cancer 160:140–149. https://doi.org/10.1016/j.ejca.2021.10.023
doi: 10.1016/j.ejca.2021.10.023
pubmed: 34838371
Pasquali S, Yim G, Vohra RS et al (2017) Survival after neoadjuvant and adjuvant treatments compared to surgery alone for resectable esophageal carcinoma: a network meta-analysis. Ann Surg 265:481–491. https://doi.org/10.1097/SLA.0000000000001905
doi: 10.1097/SLA.0000000000001905
pubmed: 27429017
Motoi F, Kosuge T, Ueno H et al (2019) Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol 49:190–194. https://doi.org/10.1093/jjco/hyy190
doi: 10.1093/jjco/hyy190
pubmed: 30608598
Motoi F, Unno M (2020) Adjuvant and neoadjuvant treatment for pancreatic adenocarcinoma. Jpn J Clin Oncol 50:483–489. https://doi.org/10.1093/jjco/hyaa018
doi: 10.1093/jjco/hyaa018
pubmed: 32083290
Birrer DL, Golcher H, Casadei R et al (2021) Neoadjuvant therapy for resectable pancreatic cancer: a new standard of care. pooled data from 3 randomized controlled trials. Ann Surg 274:713–720. https://doi.org/10.1097/SLA.0000000000005126
doi: 10.1097/SLA.0000000000005126
pubmed: 34334656
Yamaguchi J, Yokoyama Y, Fujii T et al (2022) Results of a phase II study on the use of neoadjuvant chemotherapy (FOLFIRINOX or GEM/nab-PTX) for borderline-resectable pancreatic cancer (NUPAT-01). Ann Surg 275:1043–1049. https://doi.org/10.1097/SLA.0000000000005430
doi: 10.1097/SLA.0000000000005430
pubmed: 35258510
Nordlinger B, Sorbye H, Glimelius B et al (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 371:1007–1016. https://doi.org/10.1016/S0140-6736(08)60455-9
doi: 10.1016/S0140-6736(08)60455-9
pubmed: 18358928
pmcid: 2277487
Chalabi M, Fanchi LF, Dijkstra KK et al (2020) Neoadjuvant immunotherapy leads to pathological responses in MMR-proficient and MMR-deficient early-stage colon cancers. Nat Med 26:566–576. https://doi.org/10.1038/s41591-020-0805-8
doi: 10.1038/s41591-020-0805-8
pubmed: 32251400
Churi CR, Shroff R, Wang Y et al (2014) Mutation profiling in cholangiocarcinoma: prognostic and therapeutic implications. PLoS One 9:e115383. https://doi.org/10.1371/journal.pone.0115383
doi: 10.1371/journal.pone.0115383
pubmed: 25536104
pmcid: 4275227
Lubner SJ, Mahoney MR, Kolesar JL et al (2010) Report of a multicenter phase II trial testing a combination of biweekly bevacizumab and daily erlotinib in patients with unresectable biliary cancer: a phase II Consortium study. J Clin Oncol 28:3491–3497. https://doi.org/10.1200/JCO.2010.28.4075
doi: 10.1200/JCO.2010.28.4075
pubmed: 20530271
pmcid: 2917213