Biliary Tract Cancer at CT: A Radiomics-based Model to Predict Lymph Node Metastasis and Survival Outcomes

Abstract Background: The prognostic nutritional index, a marker of nutritional status and systemic inflammation, is a known biomarker for various cancers. However, few studies have evaluated the predictive value of the prognostic nutritional index in patients with biliary tract cancer. Therefore, we investigated the prognostic significance of the prognostic nutritional index and developed a risk-stratification system to identify prognostic factors in patients with biliary tract cancer.Methods: Between July 2010 and March 2021, 117 patients with biliary tract cancer were recruited to this single-center retrospective study. The relationship between clinicopathological variables, including the prognostic nutritional index and overall survival, was analyzed using univariate and multivariate analyses. P < 0.05 was considered statistically significant.Results: The median age was 75 (range, 38–92) years. Thirty patients had intrahepatic cholangiocarcinoma; 29, gallbladder carcinoma; 28, distal cholangiocarcinoma; 16, ampullary carcinoma; and 13, perihilar cholangiocarcinoma. R0 resection was achieved in 99 patients. In univariate analysis, the prognostic nutritional index (< 42), lymph node metastasis, carbohydrate antigen 19-9 level (> 20 U/mL), preoperative cholangitis, tumor differentiation, operation time (≥ 360 minutes), and R1–2 resection were significant risk factors for overall survival. The prognostic nutritional index (P = 0.007), lymph node metastasis (P = 0.024), and tumor differentiation (P = 0.008) were independent prognostic factors in the multivariate analysis. A combined score of the prognostic nutritional index and pathological findings outperformed each marker alone, in terms of discriminatory power.Conclusions: The prognostic nutritional index, lymph node metastasis, and tumor differentiation were independent prognostic predictors after surgical resection in patients with biliary tract cancer. A combined prediction model using the prognostic nutritional index and pathological findings accurately predicted prognosis and can be applied as a novel prognostic indicator for patients with biliary tract cancer.

Download Full-text

Prognostic factor of carcinoma of the ampulla of vater after surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.270 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 270-270 ◽

Cited By ~ 1

Author(s):

Shinjiro Tomiyasu ◽

Eri Oda ◽

Hiroshi Tanaka ◽

Shinji Ishikawa ◽

Hiroki Sugita ◽

...

Keyword(s):

Prognostic Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Biliary Tract ◽

Biliary Tract Cancer ◽

Tnm Stage ◽

Tract Cancer ◽

Node Metastasis ◽

Duodenal Invasion ◽

Pancreatic Invasion

270 Background: General rules for biliary tract cancer in Japan were revised and Stage of biliary tract cancer was compliant with the seventh UICC. Carcinoma of the Ampulla Vater (CAV) is relatively good prognosis among the biliary tract cancer, such as lymph node metastasis, pancreatic invasion and perineural invasion has been reported to be prognostic factors. We investigated the validity of TNM-Stage by examining the prognostic factors from the outcome of resection experienced. Methods: To evaluate prognostic factors after surgery based on a series of 70 patients of CAV from 1996 to 2014. Twenty-eight patients received pancreatoduodenectomy (PD), 25 patients received pylorus-preserving pancreatoduodenectomy (PPPD) and 17 patients received subtotal stomach-preserving pancreatoduodenectomy (SSPPD). We reviewed and analyzed the clinicopathologic data, surgical outcomes, recurrence and survival. Results: Actuarial disease-specific survival (DSS) was 65 % at five years. In univariate analysis, pancreatic invasion, lymph node metastasis and duodenal invasion are significantly poor prognosis. In multivariate analysis, pancreatic invasion is the only poor prognostic factor (p = 0.0023, hazard ratio (HR) 5.31 [confidence interval (CI) 1.77-18.9 95%]); lymph node metastasis and duodenal invasion are not significantly different (p = 0.0672 and 0.8769, respectively). Also, in the study of relapse risk factors, pancreatic invasion and lymph node metastasis are significantly different. In TNM-Stage II, those of T3N0, 1 are poor prognosis than T1, 2N1 (p = 0.0334). Conclusions: Pancreatic invasion is an independent poor prognostic and recurrence risk factor. The Stage of Japanese Society of Biliary Surgery has reflect prognosis than TNM-Stage in carcinoma of the Ampulla Vater.

Download Full-text

A combined prediction model for biliary tract cancer using the prognostic nutritional index and pathological findings: a single-center retrospective study

BMC Gastroenterology ◽

10.1186/s12876-021-01957-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masashi Utsumi ◽

Koji Kitada ◽

Naoyuki Tokunaga ◽

Takamitsu Kato ◽

Toru Narusaka ◽

...

Keyword(s):

Prognostic Factors ◽

Lymph Node ◽

Biliary Tract ◽

Biliary Tract Cancer ◽

Prognostic Nutritional Index ◽

Tumor Differentiation ◽

Pathological Findings ◽

Tract Cancer ◽

Node Metastasis ◽

Nutritional Index

Abstract Background The prognostic nutritional index, a marker of nutritional status and systemic inflammation, is a known biomarker for various cancers. However, few studies have evaluated the predictive value of the prognostic nutritional index in patients with biliary tract cancer. Therefore, we investigated the prognostic significance of the prognostic nutritional index, and developed a risk-stratification system to identify prognostic factors in patients with biliary tract cancer. Methods Between July 2010 and March 2021, 117 patients with biliary tract cancer were recruited to this single-center, retrospective study. The relationship between clinicopathological variables, including the prognostic nutritional index, and overall survival was analyzed using univariate and multivariate analyses. A P < 0.05 was considered statistically significant. Results The median age was 75 (range 38–92) years. Thirty patients had intrahepatic cholangiocarcinoma; 29, gallbladder carcinoma; 27, distal cholangiocarcinoma; 17, ampullary carcinoma; and 13, perihilar cholangiocarcinoma. Curative (R0) resection was achieved in 99 patients. In univariate analysis, the prognostic nutritional index (< 42), lymph node metastasis, carbohydrate antigen 19-9 level (> 20 U/mL), preoperative cholangitis, tumor differentiation, operation time (≥ 360 min), and R1–2 resection were significant risk factors for overall survival. The prognostic nutritional index (P = 0.027), lymph node metastasis (P = 0.040), and tumor differentiation (P = 0.006) were independent prognostic factors in multivariate analysis. A combined score of the prognostic nutritional index and pathological findings outperformed each marker alone, in terms of discriminatory power. Conclusions The prognostic nutritional index, lymph node metastasis, and tumor differentiation were independent prognostic factors after surgical resection in patients with biliary tract cancer. A combined prediction model using the prognostic nutritional index and pathological findings accurately predicted prognosis, and can be used as a novel prognostic factor in patients with biliary tract cancer.

Download Full-text

Lymph Node Metastasis in the Biliary Tract Carcinoma: CT Evaluation

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1994.31.1.119 ◽

1994 ◽

Vol 31 (1) ◽

pp. 119

Author(s):

Young Soo Do ◽

Byung Hee Lee ◽

Kie Hwan Kim ◽

Soo Yil Chin ◽

Ah Ra Lee

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Biliary Tract ◽

Biliary Tract Carcinoma ◽

Node Metastasis ◽

Ct Evaluation

Download Full-text

Treatment efficacy in patients with advanced biliary tract cancer receiving gemcitabine and cisplatin and 21-h infusional 5-FU: An analysis of 17 cases.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e15195 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e15195-e15195

Author(s):

Mozaffar Aznab ◽

Kiumars Eslam pia ◽

Khosro Setayeshi ◽

Mansour Rezaei ◽

Kaveh Kavianymoghadam

Keyword(s):

Lymph Node ◽

Liver Metastasis ◽

Gallbladder Cancer ◽

Biliary Tract ◽

Biliary Tract Cancer ◽

Medical Sciences ◽

Curative Surgery ◽

Local Invasion ◽

Tract Cancer ◽

Age Range

e15195 Background:Biliary tract a group of tumors which only a minority of patients is eligible for curative surgery. The purpose of this study was to identify efficacy treatment of gemcitabine, cisplatin, and 21h infusional 5-FU in patients with advanced BTC receiving this therapy, and the median time to progression and OS time. Methods: The data of 17 patients with advanced biliary tract cancer who referred to clinic oncology of Kermanshah University of Medical Sciences, which received treatment from January 2009 to December 2012 were collected. Patients with gallbladder cancer with local invasion into near structures or metastatic to lymph node and or liver and or peritoneal seeding and also patients with cholangiocarcinom were randomized to recieveing chemotherapy consisting of cycles of continuous infusion of 5-FU for 21-hours (600 mg/m2) days 1, 2, 3, and 4. Gemcitabine was given at dose of 1,250 mg/m2 days 1 and 8 and cisplatin was given at dose of 60 mg/m2 day 1 with G-csf every support. Each cycle repeated every 21 days for 6-7 cycles. Results: A total of 17 patients with age range 41-61 years studied.58.8% female and 41.2% were male. The 11 patients were gallbladder cancer with only local invasion into surrounding structures in 7 pts and 2 pts with only lymph node and peritoneal involving and 2 pts with lymph node and peritoneal involving and liver metastasis, and 6 patients were cholangiocarcinoma with lymph node and peritoneal involving in 3 pts and one pts with lymph node involving and one pts with liver metastasis. Four out of the 11 patients with gallbladder cancer with local invasion survived above 29 months one pts above 20 months. Means and medians for TTP of 6 pts which disease progressed was 11.2 and 9.6 months, respectively. Means for OS Time of 17 pts was 32 months. The overall 75.5% of pts are alive. This regimen was well tolerated, with neutropenia and thrombocytopenia as the most significant toxicities. Conclusions: The triple therapy with Gemcitabine cisplatin, 5-FU showed efficacy with manageable toxicity in patients with advanced BTC and demonstrated that the addition infusional 5-FU to cisplatin and gemcitabine afforded significant PFS and OS benefits.

Download Full-text

Clinical outcomes and prognostic factors of adjuvant treatment in resectable biliary tract cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.370 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 370-370 ◽

Cited By ~ 2

Author(s):

Ji Hyung Hong

Keyword(s):

Prognostic Factors ◽

Clinical Outcomes ◽

Biliary Tract ◽

Adjuvant Treatment ◽

Biliary Tract Cancer ◽

Treatment Modality ◽

Perineural Invasion ◽

Histologic Grade ◽

Survival Outcomes ◽

Tract Cancer

370 Background: The survival outcomes and prognostic factors of adjuvant treatment after resection for biliary tract cancer (BTC) has not been clearly established. We analyzed the clinical outcomes and prognostic factors of patients with resected BTCs between adjuvant treatment and non-adjuvant treatment group. Methods: A total 189 patients of BTC were treated with surgery followed by adjuvant chemotherapy or concurrent chemoradiotherapy between Jan. 2008 and Jan. 2013. We retrospectively analyzed the clinical characteristics and recurrence and survival outcomes with following variables: histologic grade, resected margin status, lymphatic/vascular/perineural invasion, T and N stage, treatment modality. Results: Median age at diagnosis was 64 years (range: 32-85). Of the total 189 patients, R0 resection was done in 152 patients (80.4%). Among the 73 patients with adjuvant treatment, forty-one patients (21.6%) were treated with adjuvant 5-FU based systemic chemotherapy and 31 patients with chemoradiotherapy (16.5%). Recurrence rate were 39.7%. Median disease free survival (DFS) time was 58.1 months (95% CI, 38.9-77.3) and median overall survival (OS) time was 87.8 months (95% CI, 79.5-96.0). Adjuvant treatment showed the tendency to improve DFS with 39.0 months (95% CI, 8.9-69.1) in the adjuvant group compared with 57.0 months (95% CI, 39.5-74.5) in the non-adjuvant group, however, without statistical significance (p=0.113). Between the recurrent and non-recurrent group, perineural invasion, lymphatic invasion and poorly differentiated histology showed statistical significant difference, respectively (65.3% vs 35% ; p <.001, 28% vs 14.9% ; p = .028, and 8.1% vs 7.1% ; p = .011). Presence of perineural invasion showed association with RFS (HR= 1.543; 95% CI 1.133-2.102, p=.006). There was no other significant correlation in R1 resection, poor histologic grade, lymphatic and vascular invasion, chemotherapy regimen, and treatment modality with survival outcome. Conclusions: Perineural invasion could be a potential prognostic factor for recurrence. Further prospective study should be warranted to confirm this data.

Download Full-text

CT-based Radiomics for Biliary Tract Cancer: A Possible Solution for Predicting Lymph Node Metastases

Radiology ◽

10.1148/radiol.2018182158 ◽

2019 ◽

Vol 290 (1) ◽

pp. 99-100 ◽

Cited By ~ 2

Author(s):

Andrea Laghi ◽

Cecilia Voena

Keyword(s):

Lymph Node ◽

Biliary Tract ◽

Biliary Tract Cancer ◽

Lymph Node Metastases ◽

Tract Cancer ◽

Node Metastases

Download Full-text

Comparison of Survival Outcomes with or Without Para-aortic Lymphadenectomy in Surgical Patients with Stage IB1-IIA2 Cervical Cancer in China from 2004-2016

10.21203/rs.3.rs-506335/v1 ◽

2021 ◽

Author(s):

Chunlin Chen ◽

Hui Duan ◽

Wenling Zhang ◽

Hongwei Zhao ◽

Li Wang ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Pelvic Lymphadenectomy ◽

Pelvic Lymph Node ◽

Surgical Patients ◽

Survival Outcomes ◽

Node Metastasis ◽

Pelvic Lymph Node Metastasis ◽

Aortic Lymph Node

Abstract Background: Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer.Methods: We retrospectively compared the survival outcomes of 8802 cervical cancer patients with stage IB1-IIA2 (FIGO 2009) from 37 hospitals in mainland China, who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n=8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n=357).Results: Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastasis, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph node metastasized, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity. Conclusion: Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.

Download Full-text