Significance of dysplasia in bile duct resection margin in patients with extrahepatic cholangiocarcinoma: A retrospective analysis

Table 1 Baseline characteristic profiles and clinical outcomes in patient with extrahepatic cholangiocarcinoma

Baseline characteristics
Age (yr, ≤ 70/ > 70)	57/ 59
Gender (female/male)	49/ 67
Comorbidity (-/+)	75/ 41
Location of tumor (distal CBD/proximal CBD/CHD or Klatskin tumor)	51/43/22
Preoperative drainage
None	5
Endoscopic bile drainage	87
PTBD	24
Resection margin
Negative	72
LGD positive	19
HGD/CIS positive	25
T stage (T1/2/3/4)	42/ 49/ 25/ 0
N stage (0/1)	82/ 34
Perineural invasion (-/+)	41/ 75
Lymphatic invasion (-/+)	81/ 35
Differentiation (well/ moderate/ poor)	18/ 72/ 26
CA 19-9 (≤ 37/> 37)	44 / 72
Op method
BDR	24
PPPD or Whipple operation	70
BDR + hepatectomy	19
BDR+ PPPD or Whipple + hepatectomy	3
Adjuvant therapy (-/+)	70 / 46
Clinical outcomes
Recurrence rate	63 (54.3)
Time from operation to recurrence	13 mo
Op related death	10 (8.6)
	≤ 70 years old: 2/ 57 (3.5)
	> 70 years old: 8/ 59 (13.6)
Mortality	77 (66.4)
Cancer related mortality	65/ 77(84.4)
Overall survival (mean)	44.2 ± 3.43 mo

Values are n (%) or the mean ± standard deviation (SD) or mean (range). EHCC: Extrahepatic cholangiocarcinoma; CBD: Common bile duct; CHD: Common hepatic duct; PTBD: Percutaneous transhepatic biliary drainage; LGD: Low-grade dysplasia, HGD: High-grade dysplasia; CIS: Carcinoma in situ; Op: Operation; BDR: BDile duct resection; PPPD: Pylorus preserving pancreaticoduodenectomy.

Table 2 Univariate and multivariate analyses for prognostic factors for overall survival in patients with extrahepatic cholangiocarcinoma

Univariate analysis for overall survival
	Hazard ratio (95%CI)	P value
Age (> 70 yr old)	1.98 (1.21–3.23)	< 0.01
Gender (female)	1.18 (0.37–3.72)	0.32
Location of tumor		0.02
distal CBD	1
prox. CBD	0.32 (0.10–1.02)	0.06
CHD or Klatskin tumor	3.73 (0.69–20.2)	0.13
Op method		0.35
BDR	1
PPPD or Whipple operation	1.09 (0.97- 1.23)	0.42
BDR + hepatectomy	1.88 (0.28-12.63)	0.51
BDR+ PPPD or Whipple + hepatectomy	19.35 (2.78-134.64)	< 0.01
Resection margin		< 0.01
Negative	1
LGD positive	0.83 (0.42-1.63)	0.58
HGD/CIS positive	7.72 (1.04-57.52)	0.001
T stage		0.283
T1	1
T2	0.95 (0.15-5.94)	0.105
T3	1.53 (0.82-3.14)	0.283
N stage
N(-)	1
N(+)	1.31 (0.96-2.54)	0.120
Perineural invasion	1.28 (0.8-2.1)	0.329
Lymphatic invasion	1.13 (0.7-1.9)	0.624
Differentiation	1.16 (0.5-2.6)	0.814
Well	1
Moderate	0.73 (0.20-2.63)	0.625
Poor	2.07 (0.50-8.56)	0.317
CA 19-9	1.00 (0.99-1.00)	0.592
Comorbidity	1.38 (0.92-2.21)	0.173
History of malignancy	0.88 (0.4-1.8)	0.707
Adjuvant therapy	0.31 (0.11-0.86)	0.024
Multivariate analysis for overall survival
Age (≥ 70 yr old)	1.9 (1.2-3.1)	0.01
HGD/CIS positive margin	2.47 (1.4-4.2)	0.002

EHCC: Extrahepatic cholangiocarcinoma; CBD: Common bile duct; CHD: Common hepatic duct; PTBD: Percutaneous transhepatic biliary drainage; LGD: Low-grade dysplasia, HGD: High-grade dysplasia; CIS: Carcinoma in situ; Op: Operation; BDR: BDile duct resection; PPPD: Pylorus preserving pancreaticoduodenectomy.