Distal Cholangiocarcinoma and Pancreas Adenocarcinoma: Are They Really the Same Disease? A 13-Institution Study from the US Extrahepatic Biliary Malignancy Consortium and the Central Pancreas Consortium

Cecilia G. Ethun, Alexandra G. Lopez-Aguiar, Timothy M. Pawlik, George Poultsides, Kamran Idrees, Ryan C. Fields, Sharon M. Weber, Clifford Cho, Robert C. Martin, Charles R. Scoggins, Perry Shen, Carl Schmidt, Ioannis Hatzaras, David Bentrem, Syed Ahmad, Daniel Abbott, Hong Jin Kim, Nipun Merchant, Charles A. Staley, David A. Kooby & 1 others Shishir K. Maithel

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Abstract

Background Distal cholangiocarcinoma (DC) and pancreatic ductal adenocarcinoma (PDAC) are often managed as 1 entity, yet direct comparisons are lacking. Our aim was to use 2 large multi-institutional databases to assess treatment, pathologic, and survival differences between these diseases. Study Design This study included patients with DC and PDAC who underwent curative-intent pancreaticoduodenectomy from 2000 to 2015 at 13 institutions comprising the US Extrahepatic Biliary Malignancy and Central Pancreas Consortiums. Primary endpoint was disease-specific survival (DSS). Results Of 1,463 patients, 224 (15%) had DC and 1,239 (85%) had PDAC. Compared with PDAC, DC patients were less likely to be margin-positive (19% vs 25%; p = 0.005), lymph node (LN)-positive (55% vs 69%; p < 0.001), and receive adjuvant therapy (57% vs 71%; p < 0.001). Of DC patients treated with adjuvant therapy, 62% got gemcitabine alone and 16% got gemcitabine/cisplatin. Distal cholangiocarcinoma was associated with improved median DSS (40 months) compared with PDAC (22 months; p < 0.001), which persisted on multivariable analysis (hazard ratio 0.65; 95% CI 0.50 to 0.84; p = 0.001). Lymph node involvement was the only factor independently associated with decreased DSS for both DC and PDAC. The DC/LN-positive patients had similar DSS as PDAC/LN-negative patients (p = 0.74). Adjuvant therapy (chemotherapy ± radiation) was associated with improved median DSS for PDAC/LN-positive patients (21 vs 13 months; p = 0.001), but not for DC patients (38 vs 40 months; p = 0.62), regardless of LN status. Conclusions Distal cholangiocarcinoma and pancreatic ductal adenocarcinoma are distinct entities. Distal cholangiocarcinoma has a favorable prognosis compared with PDAC, yet current adjuvant therapy regimens are only associated with improved survival in PDAC, not DC. Therefore, treatment paradigms used for PDAC should not be extrapolated to DC, despite similar operative approaches, and novel therapies for DC should be explored.

LanguageEnglish (US)
Pages406-413
Number of pages8
JournalJournal of the American College of Surgeons
Volume224
Issue number4
DOIs
StatePublished - Apr 1 2017

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Cholangiocarcinoma
Pancreas
Adenocarcinoma
Neoplasms
Lymph Nodes
gemcitabine
Survival
Therapeutics
Pancreaticoduodenectomy
Adjuvant Chemotherapy
Cisplatin

ASJC Scopus subject areas

  • Surgery

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Distal Cholangiocarcinoma and Pancreas Adenocarcinoma : Are They Really the Same Disease? A 13-Institution Study from the US Extrahepatic Biliary Malignancy Consortium and the Central Pancreas Consortium. / Ethun, Cecilia G.; Lopez-Aguiar, Alexandra G.; Pawlik, Timothy M.; Poultsides, George; Idrees, Kamran; Fields, Ryan C.; Weber, Sharon M.; Cho, Clifford; Martin, Robert C.; Scoggins, Charles R.; Shen, Perry; Schmidt, Carl; Hatzaras, Ioannis; Bentrem, David; Ahmad, Syed; Abbott, Daniel; Kim, Hong Jin; Merchant, Nipun; Staley, Charles A.; Kooby, David A.; Maithel, Shishir K.

In: Journal of the American College of Surgeons, Vol. 224, No. 4, 01.04.2017, p. 406-413.

Research output: Contribution to journalArticle

Ethun, CG, Lopez-Aguiar, AG, Pawlik, TM, Poultsides, G, Idrees, K, Fields, RC, Weber, SM, Cho, C, Martin, RC, Scoggins, CR, Shen, P, Schmidt, C, Hatzaras, I, Bentrem, D, Ahmad, S, Abbott, D, Kim, HJ, Merchant, N, Staley, CA, Kooby, DA & Maithel, SK 2017, 'Distal Cholangiocarcinoma and Pancreas Adenocarcinoma: Are They Really the Same Disease? A 13-Institution Study from the US Extrahepatic Biliary Malignancy Consortium and the Central Pancreas Consortium' Journal of the American College of Surgeons, vol. 224, no. 4, pp. 406-413. https://doi.org/10.1016/j.jamcollsurg.2016.12.006
Ethun, Cecilia G. ; Lopez-Aguiar, Alexandra G. ; Pawlik, Timothy M. ; Poultsides, George ; Idrees, Kamran ; Fields, Ryan C. ; Weber, Sharon M. ; Cho, Clifford ; Martin, Robert C. ; Scoggins, Charles R. ; Shen, Perry ; Schmidt, Carl ; Hatzaras, Ioannis ; Bentrem, David ; Ahmad, Syed ; Abbott, Daniel ; Kim, Hong Jin ; Merchant, Nipun ; Staley, Charles A. ; Kooby, David A. ; Maithel, Shishir K. / Distal Cholangiocarcinoma and Pancreas Adenocarcinoma : Are They Really the Same Disease? A 13-Institution Study from the US Extrahepatic Biliary Malignancy Consortium and the Central Pancreas Consortium. In: Journal of the American College of Surgeons. 2017 ; Vol. 224, No. 4. pp. 406-413.
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title = "Distal Cholangiocarcinoma and Pancreas Adenocarcinoma: Are They Really the Same Disease? A 13-Institution Study from the US Extrahepatic Biliary Malignancy Consortium and the Central Pancreas Consortium",
abstract = "Background Distal cholangiocarcinoma (DC) and pancreatic ductal adenocarcinoma (PDAC) are often managed as 1 entity, yet direct comparisons are lacking. Our aim was to use 2 large multi-institutional databases to assess treatment, pathologic, and survival differences between these diseases. Study Design This study included patients with DC and PDAC who underwent curative-intent pancreaticoduodenectomy from 2000 to 2015 at 13 institutions comprising the US Extrahepatic Biliary Malignancy and Central Pancreas Consortiums. Primary endpoint was disease-specific survival (DSS). Results Of 1,463 patients, 224 (15{\%}) had DC and 1,239 (85{\%}) had PDAC. Compared with PDAC, DC patients were less likely to be margin-positive (19{\%} vs 25{\%}; p = 0.005), lymph node (LN)-positive (55{\%} vs 69{\%}; p < 0.001), and receive adjuvant therapy (57{\%} vs 71{\%}; p < 0.001). Of DC patients treated with adjuvant therapy, 62{\%} got gemcitabine alone and 16{\%} got gemcitabine/cisplatin. Distal cholangiocarcinoma was associated with improved median DSS (40 months) compared with PDAC (22 months; p < 0.001), which persisted on multivariable analysis (hazard ratio 0.65; 95{\%} CI 0.50 to 0.84; p = 0.001). Lymph node involvement was the only factor independently associated with decreased DSS for both DC and PDAC. The DC/LN-positive patients had similar DSS as PDAC/LN-negative patients (p = 0.74). Adjuvant therapy (chemotherapy ± radiation) was associated with improved median DSS for PDAC/LN-positive patients (21 vs 13 months; p = 0.001), but not for DC patients (38 vs 40 months; p = 0.62), regardless of LN status. Conclusions Distal cholangiocarcinoma and pancreatic ductal adenocarcinoma are distinct entities. Distal cholangiocarcinoma has a favorable prognosis compared with PDAC, yet current adjuvant therapy regimens are only associated with improved survival in PDAC, not DC. Therefore, treatment paradigms used for PDAC should not be extrapolated to DC, despite similar operative approaches, and novel therapies for DC should be explored.",
author = "Ethun, {Cecilia G.} and Lopez-Aguiar, {Alexandra G.} and Pawlik, {Timothy M.} and George Poultsides and Kamran Idrees and Fields, {Ryan C.} and Weber, {Sharon M.} and Clifford Cho and Martin, {Robert C.} and Scoggins, {Charles R.} and Perry Shen and Carl Schmidt and Ioannis Hatzaras and David Bentrem and Syed Ahmad and Daniel Abbott and Kim, {Hong Jin} and Nipun Merchant and Staley, {Charles A.} and Kooby, {David A.} and Maithel, {Shishir K.}",
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T1 - Distal Cholangiocarcinoma and Pancreas Adenocarcinoma

T2 - Journal of the American College of Surgeons

AU - Ethun, Cecilia G.

AU - Lopez-Aguiar, Alexandra G.

AU - Pawlik, Timothy M.

AU - Poultsides, George

AU - Idrees, Kamran

AU - Fields, Ryan C.

AU - Weber, Sharon M.

AU - Cho, Clifford

AU - Martin, Robert C.

AU - Scoggins, Charles R.

AU - Shen, Perry

AU - Schmidt, Carl

AU - Hatzaras, Ioannis

AU - Bentrem, David

AU - Ahmad, Syed

AU - Abbott, Daniel

AU - Kim, Hong Jin

AU - Merchant, Nipun

AU - Staley, Charles A.

AU - Kooby, David A.

AU - Maithel, Shishir K.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background Distal cholangiocarcinoma (DC) and pancreatic ductal adenocarcinoma (PDAC) are often managed as 1 entity, yet direct comparisons are lacking. Our aim was to use 2 large multi-institutional databases to assess treatment, pathologic, and survival differences between these diseases. Study Design This study included patients with DC and PDAC who underwent curative-intent pancreaticoduodenectomy from 2000 to 2015 at 13 institutions comprising the US Extrahepatic Biliary Malignancy and Central Pancreas Consortiums. Primary endpoint was disease-specific survival (DSS). Results Of 1,463 patients, 224 (15%) had DC and 1,239 (85%) had PDAC. Compared with PDAC, DC patients were less likely to be margin-positive (19% vs 25%; p = 0.005), lymph node (LN)-positive (55% vs 69%; p < 0.001), and receive adjuvant therapy (57% vs 71%; p < 0.001). Of DC patients treated with adjuvant therapy, 62% got gemcitabine alone and 16% got gemcitabine/cisplatin. Distal cholangiocarcinoma was associated with improved median DSS (40 months) compared with PDAC (22 months; p < 0.001), which persisted on multivariable analysis (hazard ratio 0.65; 95% CI 0.50 to 0.84; p = 0.001). Lymph node involvement was the only factor independently associated with decreased DSS for both DC and PDAC. The DC/LN-positive patients had similar DSS as PDAC/LN-negative patients (p = 0.74). Adjuvant therapy (chemotherapy ± radiation) was associated with improved median DSS for PDAC/LN-positive patients (21 vs 13 months; p = 0.001), but not for DC patients (38 vs 40 months; p = 0.62), regardless of LN status. Conclusions Distal cholangiocarcinoma and pancreatic ductal adenocarcinoma are distinct entities. Distal cholangiocarcinoma has a favorable prognosis compared with PDAC, yet current adjuvant therapy regimens are only associated with improved survival in PDAC, not DC. Therefore, treatment paradigms used for PDAC should not be extrapolated to DC, despite similar operative approaches, and novel therapies for DC should be explored.

AB - Background Distal cholangiocarcinoma (DC) and pancreatic ductal adenocarcinoma (PDAC) are often managed as 1 entity, yet direct comparisons are lacking. Our aim was to use 2 large multi-institutional databases to assess treatment, pathologic, and survival differences between these diseases. Study Design This study included patients with DC and PDAC who underwent curative-intent pancreaticoduodenectomy from 2000 to 2015 at 13 institutions comprising the US Extrahepatic Biliary Malignancy and Central Pancreas Consortiums. Primary endpoint was disease-specific survival (DSS). Results Of 1,463 patients, 224 (15%) had DC and 1,239 (85%) had PDAC. Compared with PDAC, DC patients were less likely to be margin-positive (19% vs 25%; p = 0.005), lymph node (LN)-positive (55% vs 69%; p < 0.001), and receive adjuvant therapy (57% vs 71%; p < 0.001). Of DC patients treated with adjuvant therapy, 62% got gemcitabine alone and 16% got gemcitabine/cisplatin. Distal cholangiocarcinoma was associated with improved median DSS (40 months) compared with PDAC (22 months; p < 0.001), which persisted on multivariable analysis (hazard ratio 0.65; 95% CI 0.50 to 0.84; p = 0.001). Lymph node involvement was the only factor independently associated with decreased DSS for both DC and PDAC. The DC/LN-positive patients had similar DSS as PDAC/LN-negative patients (p = 0.74). Adjuvant therapy (chemotherapy ± radiation) was associated with improved median DSS for PDAC/LN-positive patients (21 vs 13 months; p = 0.001), but not for DC patients (38 vs 40 months; p = 0.62), regardless of LN status. Conclusions Distal cholangiocarcinoma and pancreatic ductal adenocarcinoma are distinct entities. Distal cholangiocarcinoma has a favorable prognosis compared with PDAC, yet current adjuvant therapy regimens are only associated with improved survival in PDAC, not DC. Therefore, treatment paradigms used for PDAC should not be extrapolated to DC, despite similar operative approaches, and novel therapies for DC should be explored.

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