Invasion Depth Measured in Millimeters is a Predictor of Survival in Patients with Distal Bile Duct Cancer: Decision Tree Approach

• Published in: World journal of surgery Vol. 41; no. 1; pp. 232 - 240
• Main Authors: Min, Kyueng-Whan, Kim, Dong-Hoon, Son, Byoung Kwan, Kim, Eun-Kyung, Ahn, Sang Bong, Kim, Seong Hwan, Jo, Yun Ju, Park, Young Sook, Seo, Jinwon, Oh, Young Ha, Oh, Sukjoong, Kim, Ho Young, Kwon, Mi Jung, Min, Soo Kee, Park, Hye-Rim, Choe, Ji-Young, Jeon, Jang Yong, Ha, Hong Il, Lee, Jung Woo
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2017; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adult; Aged; Aged, 80 and over; Bile Duct; Bile Duct Cancer; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Wall; Cardiac Surgery; Cholangiocarcinoma - mortality; Cholangiocarcinoma - pathology; Decision Trees; Distal Bile Duct; Female; General Surgery; Humans; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - pathology; Original Scientific Report; Perineural Invasion; Prognosis; Retrospective Studies; Surgery; Thoracic Surgery; Vascular Surgery; Bile Duct Cancer; Perineural Invasion; Bile Duct; Bile Duct Wall; Distal Bile Duct
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-016-3687-7

Background AJCC staging system is unreliable for predicting survival in distal bile duct (DBD) cancer patients, due to inter-observer variation. Measured depth of invasion (DOI) is suggested to be more accurate to predict patients’ clinical outcome in extra-hepatic cholangiocarcinomas, but its significance in DBD cancer and cutoff values are still debatable. This study aimed to identify the optimal cutoff value of DOI in relation to prognosis in DBD cancer patients. Methods Data of 179 patients with DBD adenocarcinoma treated in three institutions were investigated. Under microscopic review, DOI was measured. The relationships between the clinicopathological parameters and the groups based on DOI (≤3; 3–10; >10 mm) were evaluated, and the survival times of each group based on DOI and T classification were compared. Results Deeply invading tumors exhibited a greater tendency toward the infiltrative type, high histological grade, AJCC stage, and pancreatic, duodenal, lymphovascular and perineural invasion. The measured DOI was significantly correlated with worse relapse-free and overall survival (all p  < 0.05). In multivariate analyses, the DOI remained as one of the prognostic factors (all p  < 0.05), while T classification was not a significant prognostic factor. The new prognostic models (low, intermediate, and high risk) that applied DOI and nodal metastasis showed significant difference in recurrence and survival rate (all p  < 0.05). Conclusions On the basis of the proposed cutoff value, the DOI could be clear and meaningful, overcoming the vagueness of the T classification for predicting clinical outcomes in patients with DBD carcinoma.