Risk factors and early recurrence patterns following curative-intent resection of distal cholangiocarcinoma.

BACKGROUND

Distal cholangiocarcinoma (DCC) has poor prognosis, with >50% affected patients experiencing early recurrence (ER) within 12 months after curative-intent surgery. This retrospective study analyzed ER characteristics, survival outcomes, and risk factors of DCC.

METHODS

We categorized 519 patients with DCC who underwent curative-intent surgery at Seoul National University Hospital (2008-2023) into ER (n=115) and non-ER (n=404) groups. Primary endpoints were ER and overall survival (OS). We compared OS between ER and an additional non-curative reference cohort (R2/M1, n=53). Cutoffs for continuous variables were derived using the receiver operating characteristic (ROC) curve/Youden.

RESULTS

Median OS and recurrence-free survival were 53.6 and 52.4 months, respectively. Independent ER predictors were preoperative CA19-9 of >70 U/mL (hazard ratio [HR], 1.58), BMI of ≤21.0 kg/m² (HR, 2.04) or >25.0 kg/m² (HR 1.81), LNR of >15% (HR, 2.01), and postoperative CA19-9 of >37 U/mL (HR, 1.71). OS was similar between ER and R2/M1 groups (16.8 vs 15.6 months; p=0.998). In subgroup analyses stratified by ER status, adjuvant chemotherapy (including 5-FU), radiotherapy, and concurrent chemoradiotherapy were not associated with improved OS.

CONCLUSION

ER after curative-intent resection has outcomes comparable to non-curative disease, supporting risk-adapted staging and evaluation of neoadjuvant strategies for high-risk patients.