title: Patterns and relevant factors of tumor recurrence for extrahepatic bile duct carcinoma after radical resection.
abstract: OBJECTIVE
  The complete surgical removal of bile duct cancer offers the only chance of cure. Long-term survival, however, is very limited because of frequent recurrence after surgery. As it is important to know the mode of recurrence and its relevant factors for early detection, prevention, and selecting an ideal strategy for adjuvant therapy, we determined the frequent mode of recurrence after curative surgery and analyzed its risk factors.
  
  
  METHODS
  Eighty-three patients who underwent radical resection for bile duct cancer were evaluated. The tumors comprised 24 proximal and 59 middle or distal bile duct carcinomas. The clinicopathologic findings and the modes of recurrence were reviewed.
  
  
  RESULTS
  Tumor recurrence developed in 18 of 24 proximal and 34 of 59 non-proximal cancers at an average interval of 16.7 and 17.8 postoperative months, respectively. T-stage (p=0.031) and age (p=0.019) were independent factors affecting recurrence on multivariate analysis. The factors, however, were different according to tumor location that while histological grade was the only factor for proximal tumor, nodal status and age were independent factors for non-proximal tumors. The precise recurrent sites were identifiable in 14 proximal and 24 non-proximal lesions. While the predominant pattern of recurrence was locoregional in most proximal tumors (13/14), non-proximal tumors showed frequent recurrences at distant sites including liver, peritoneum, and lung (13/24). The median survival was longer in non-proximal (45.3 months) than proximal tumor (18.0 months), in T0,1-tumor (>120 months) than T2,3-tumor (20.4 months), and in N0-tumor (60.2 months) than N1,2-tumor (13.0 months). The 5-year survival rates were also higher in non-proximal cancers (46.7% vs. 32.0%).
  
  
  CONCLUSIONS
  Our results suggested that the need for postoperative adjuvant therapy, and strategies to detect and to prevent recurrence should be individualized not only by stage but also by tumor location to improve survival in patients with extrahepatic bile duct cancer.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung-Woo
authors.initials: SW
authors.lastname: Park
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Jae Bock
authors.initials: JB
authors.lastname: Chung
authors.forename: Jin Kyung
authors.initials: JK
authors.lastname: Kang
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Jin Sup
authors.initials: JS
authors.lastname: Choi
authors.forename: Woo-Jung
authors.initials: WJ
authors.lastname: Lee
authors.forename: Byong Ro
authors.initials: BR
authors.lastname: Kim
authors.forename: Si Young
authors.initials: SY
authors.lastname: Song
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis