title: Clinicopathological analysis and prognosis of extrahepatic bile duct cancer with a microscopic positive ductal margin.
abstract: BACKGROUND
  The fate of a microscopic positive ductal margin (MPDM) of extrahepatic bile duct (EHBD) cancer is unclear. The purpose of this study was to analyse the clinicopathological features of EHBD cancer with MPDM and to identify the prognostic factors associated with survival.
  
  
  METHODS
  Between 1995 and 2007, a retrospective analysis of 464 patients who had undergone surgical resection for EHBD cancer was conducted. Clinicopathological factors likely to influence survival were assessed using univariate and multivariate analysis.
  
  
  RESULTS
  One hundred twenty-four patients had MPDM which included invasive carcinoma (IC) (n =85) and carcinoma in situ (CIS)/ high-grade dysplasia (HGD) (n = 39). The median survival (MS) of R0, R1 as CIS/ HGD, and R1 as IC were 41 months, 29 months, and 18 months, respectively. Adverse prognostic factors were 'IC' on the resection margin [HR = 1.66, 95% confidence intervals (CIs) 1.06-2.59, P = 0.026], and no use of adjuvant chemoradiotherapy (HR = 1.57, 95% CIs 1.04-2.39, P = 0.033). Adjuvant chemoradiotherapy was beneficial in patients with MPDM as IC (5-year survival rate 19.7 compared with 2.8%, P = 0.011).
  
  
  CONCLUSIONS
  The presence of MPDM is an important prognostic factor in EHBD cancer. When a ductal resection margin is positive, discrimination between 'IC' and 'CIS/ HGD' is important.
authors.affiliation: Department of Surgery, Dongguk University College of Medicine, Goyang, South Korea.
authors.forename: In Woong
authors.initials: IW
authors.lastname: Han
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.forename: Kyoung Bun
authors.initials: KB
authors.lastname: Lee
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.forename: Wooil
authors.initials: W
authors.lastname: Kwon
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Park
authors.forename: Ye Rim
authors.initials: YR
authors.lastname: Chang
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000473:pathology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000601:surgery; D059186:Chemoradiotherapy, Adjuvant; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome