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Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution

Title
Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution
Authors
Kim, Byoung HyuckKim, KyuboChie, Eui KyuKwon, JeannyJang, Jin-YoungKim, Sun WheOh, Do-YounBang, Yung-Jue
Ewha Authors
김규보
SCOPUS Author ID
김규보scopus
Issue Date
2017
Journal Title
CANCER RESEARCH AND TREATMENT
ISSN
1598-2998JCR Link2005-9256JCR Link
Citation
vol. 49, no. 2, pp. 473 - 483
Keywords
Distal cholangiocarcinomaPancreaticoduodenectomyAdjuvant chemoradiotherapy
Publisher
KOREAN CANCER ASSOCIATION
Indexed
SCIE; SCOPUS; KCI WOS scopus
Abstract
Purpose This study was conducted to evaluate the long-term outcome in patients undergoing pancreaticoduodenectomy (PD) followed by adjuvant chemoradiotherapy for distal cholangio-carcinoma (DCC) in a high-volume center and to identify the prognostic impact of clinicopathologic factors. Materials and Methods A total of 132 consecutive patients who met the inclusion criteria were retrieved from the institutional database from January 1995 to September 2009. All patients received adjuvant treatments at a median of 45 days after the surgery. Median follow-up duration was 57 months (range, 6 to 225 months) for all patients and 105 months for survivors (range, 13 to 225 months). Results The 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 70.7%, 55.7%, 49.4%, and 48.1%, respectively. Univariate analysis revealed poorly differentiated (P/D) tumors and lymph node (LN) metastasis were significantly associated with DMFS and OS. Additionally, preoperative carbohydrate antigen 19-9 level was significantly correlated with DFS, LRRFS, and DMFS. Upon multivariate analysis for OS, P/D tumors (p=0.015) and LN metastasis (p=0.003) were significant prognosticators that predicted inferior OS. Grade 3 or higher late gastrointestinal toxicity occurred in only one patient (0.8%). Conclusion Adjuvant chemoradiotherapy after PD for DCC is an effective and tolerable strategy without significant side effects. During long-term follow-up, we found that prognosis of DCC was mainly influenced by histologic differentiation and LN metastasis. For patients with these risk factors, further research should focus on improving adjuvant strategies as well as other treatment approaches.
DOI
10.4143/crt.2016.166
Appears in Collections:
의학전문대학원 > 의학과 > Journal papers
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