Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2017; 23(36): 6685-6693
Published online Sep 28, 2017. doi: 10.3748/wjg.v23.i36.6685
Prognostic value of lymphovascular invasion in Bismuth-Corlette type IV hilar cholangiocarcinoma
Bei Li, Xian-Ze Xiong, Yong Zhou, Si-Jia Wu, Zhen You, Jiong Lu, Nan-Sheng Cheng
Bei Li, Xian-Ze Xiong, Yong Zhou, Si-Jia Wu, Zhen You, Jiong Lu, Nan-Sheng Cheng, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Li B analyzed the data and wrote the manuscript; Xiong XZ and Zhou Y collected all the human materials; Wu SJ, You Z and Lu J helped with data analysis; Cheng NS designed, organized, and supervised the writing of the manuscript; all authors approved the final manuscript as submitted.
Supported by Science and Technology Support Project of Sichuan Province, No. 2015SZ0070 and No. 2014FZ0049.
Institutional review board statement: The study was reviewed and approved by the West China Hospital of Sichuan University Institutional Review Board.
Conflict-of-interest statement: We have no conflicts of interest regarding the current paper.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nan-Sheng Cheng, MD, PhD, Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China. nanshengcheng@yeah.net
Telephone: +86-28-85422465 Fax: +86-28-85422465
Received: June 18, 2017
Peer-review started: June 21, 2017
First decision: July 13, 2017
Revised: July 28, 2017
Accepted: August 25, 2017
Article in press: August 25, 2017
Published online: September 28, 2017
Processing time: 99 Days and 8 Hours
Abstract
AIM

To assess the prognostic value of lymphovascular invasion (LVI) in Bismuth-Corlette type IV hilar cholangiocarcinoma (HC) patients.

METHODS

A retrospective analysis was performed on 142 consecutively recruited type IV HC patients undergoing radical resection with at least 5 years of follow-up. Survival analysis was performed by the Kaplan-Meier method, and the association between the clinicopathologic variables and survival was evaluated by log-rank test. Multivariate analysis was adopted to identify the independent prognostic factors for overall survival (OS) and disease-free survival (DFS). Multiple logistic regression analysis was performed to determine the association between LVI and potential variables.

RESULTS

LVI was confirmed histopathologically in 29 (20.4%) patients. Multivariate analysis showed that positive resection margin (HR = 6.255, 95%CI: 3.485-11.229, P < 0.001), N1 stage (HR = 2.902, 95%CI: 1.132-7.439, P = 0.027), tumor size > 30 mm (HR = 1.942, 95%CI: 1.176-3.209, P = 0.010) and LVI positivity (HR = 2.799, 95%CI: 1.588-4.935, P < 0.001) were adverse prognostic factors for DFS. The independent risk factors for OS were positive resection margin (HR = 6.776, 95%CI: 3.988-11.479, P < 0.001), N1 stage (HR = 2.827, 95%CI: 1.243-6.429, P = 0.013), tumor size > 30 mm (HR = 1.739, 95%CI: 1.101-2.745, P = 0.018) and LVI positivity (HR = 2.908, 95%CI: 1.712-4.938, P < 0.001). LVI was associated with N1 stage and tumor size > 30 mm. Multiple logistic regression analysis indicated that N1 stage (HR = 3.312, 95%CI: 1.338-8.198, P = 0.026) and tumor size > 30 mm (HR = 3.258, 95%CI: 1.288-8.236, P = 0.013) were associated with LVI.

CONCLUSION

LVI is associated with N1 stage and tumor size > 30 mm and adversely influences DFS and OS in type IV HC patients.

Keywords: Bismuth-Corlette classification, Disease-free survival, Lymphovascular invasion, Overall survival, Hilar cholangiocarcinoma

Core tip: Previous studies have reported that lymphovascular invasion (LVI) provokes an adverse impact on the long-term survival of several malignances, including breast, gastric, and esophageal carcinoma, among many others. However, the correlation between LVI and hilar cholangiocarcinoma remains unclear. In our study, LVI was found to be an independent risk factor for overall survival and disease-free survival in Bismuth-Corlette type IV hilar cholangiocarcinoma patients. To our knowledge, this report indicates for the first time that LVI is an adverse predictor of long-term survival in the setting of type IV hilar cholangiocarcinoma.