Analysis Of Prognostic Factors And Treatment Failure After Curative Resection For Patients With Distal Cholangiocarcinoma

Purpose: This study is aim to determine the prognostic factors that affect the locoregional recurrence(LRR)and overall survival(OS)of patients with distal cholangiocarcinoma(DCCA),and to generate a map of LRR to provide clinical evidence for improving local control of patients.Methods: 124 DCCA cases registered in our hospital from 2006 to 2018 were analyzed retrospectively.The Cox proportional hazards model was used for multivariable analysis.All recurrence sites were centrally reviewed,the recurrence patterns of the patients were summarized,and LRRs were plotted on one CT scan of the template patients.Results: The median follow-up time in this research was 35.3 months(95% CI 22.1-48.5).Independent prognostic factor for locoregional recurrence-free survival was lymph node metastasis.Older age,pancreas invasion,and lymph node metastasis were independent prognostic factor for overall survival.During the follow-up period,69 patients(55.6%)developed disease progression.Among them,21 patients(30.4%)were diagnosed with liver metastases.45 patients(65.2%)had recurrence in the locoregional components.Most recurrences occurred in the nodes along the superior mesenteric artery(36.2%),nodes around the abdominal aorta(26.1%),nodes in the hepatoduodenal ligament(13.0%),nodes around the celiac artery(10.1%),and anastomotic stoma(10.1%).Conclusions: The high-risk sites of LRR after PD for primary DCCA are the nodes along the superior mesenteric artery,abdominal aorta,nodes in the hepatoduodenal ligament,nodes around the celiac artery,and anastomotic stoma.Adjuvant radiation should cover these areas to improve locoregional control for these patients.