DOI: 10.1097/sla.0000000000007138 ISSN: 0003-4932

Radial Margin Distance in Perihilar Cholangiocarcinoma

Ryusei Yamamoto, Shunsuke Onoe, Takashi Mizuno, Nobuyuki Watanabe, Shoji Kawakatsu, Masaki Sunagawa, Atsushi Ogura, Taisuke Baba, Mihoko Yamada, Yoshie Shimoyama, Kennosuke Karube, Takahiro Imaizumi, Ryo Emoto, Tomoki Ebata
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Objective:

To evaluate the prognostic impact of radial margin distance (RMD) in patients with perihilar cholangiocarcinoma (pCCA) and establish clinically relevant cutoff values.

Background:

A positive radial margin is conventionally defined by cancer cell exposure at the transection plane. However, a standardized classification for pCCA has yet to be established.

Methods:

pCCA patients who underwent tumor resection between 2005 and 2020 were retrospectively analyzed. The relationships between histologically measured RMDs and long-term outcomes were examined.

Results:

Among the 658 study patients, the median RMD was 0.4 mm (interquartile range, 0.1–1.1 mm). The hazard for overall survival peaked at an RMD of 0 mm (conventional cutoff), decreased with increasing RMD, and plateaued at approximately 1.0 mm, which was identified as the optimal threshold in rank statistics (|z|, 11.09; P <0.001). On the basis of these findings, patients were categorized into three groups according to their RMDs (0 mm (n=101, 15.3%), >0–<1.0 mm (n=356, 54.1%), and ≥1.0 mm (n=201, 30.5%)); the 5-year cumulative recurrence rates were 83.5%, 68.8%, and 23.9%, respectively ( P <0.001), with local recurrence rates of 63.0%, 37.0%, and 11.1%, respectively ( P <0.001), and the 5-year overall survival rates were 21.8%, 36.0%, and 78.5%, respectively ( P <0.001). Multivariable analysis confirmed that RMDs of 0 mm (hazard ratio, 3.15; P <0.001) and >0–<1.0 mm (hazard ratio, 2.64; P <0.001) were independent predictors of poor overall survival.

Conclusions:

RMD assessment with dual cutoffs of 0 and 1.0 mm was simple and clinically relevant and effectively stratified postoperative recurrence risk and survival in pCCA patients.

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