Time to surgery is not an oncological risk factor in patients with cholangiocarcinoma undergoing curative-intent liver surgery

Abstract

Surgical resection is the only option to achieve long-term survival in cholangiocellular carcinoma (CCA). Due to limitations of health care systems and unforeseeable events, e.g., the COVID pandemic, the time from diagnosis to surgery (time-to-surgery (TTS)) has gained great interest in malignancies. Thus, we investigated whether TTS is associated with the oncological outcome in patients who underwent surgery for CCA. A cohort of 276 patients undergoing curative-intent surgery for intrahepatic and perihilar CCA excluding individuals with neoadjuvant therapy and perioperative mortality between 2010 and 2021 were eligible for analysis. Patients were grouped according to TTS (≤ 30; 31-60; 61-90; > 90 days) and compared by Kruskal-Wallis-analysis. Survival was compared using Kaplan-Meier analysis and characteristics associated with cancer-specific survival (CSS), recurrence-free survival (RFS) and overall survival (OS) using Cox regressions. The median CSS was 39 months (3-year-CSS = 52%, 5-year-CSS = 42%) and the median RFS 20 months (3-year-CSS = 38%, 5-year-CSS = 33%). In univariable Cox regressions, TTS was not associated with CSS (p = 0.971) or RFS (p = 0.855), respectively. A grouped analysis with respect to TTS (≤ 30 days, n = 106; 31-60 days, n = 134; 61-90 days, n = 44; > 90 days, n = 29) displayed a median CSS of 38, 33, 51 and 41 months and median RFS of 17, 22, 28 and 20 months (p = 0.971 log rank; p = 0.520 log rank). No statistical difference regarding oncological risk factors were observed between the groups. This study is the first comprehensive analysis of TTS in CCA patients. Within a representative European cohort, TTS was not associated with earlier tumor recurrence or reduced CCS.

Figure 1

Oncological survival in cholangiocarcinoma stratified by time to surgery. (A) Cancer-specific in cholangiocarcinoma. The median CCS was 39 months. (B) Cancer-specific in cholangiocarcinoma stratified by time to surgery. The median CSS were 38 months (TTS 1–30 d), 33 months (TTS 31–60 d), 51 months (TTS 61–90 d) and 41 months (TTS > 90 d). (C) Recurrence-free survival in cholangiocarcinoma. The median RFS 20 months. (D) Recurrence-free survival in cholangiocarcinoma stratified by time to surgery. The median RFS were 17 months, 22 months (TTS 31–60 d), 28 months (TTS 61–90 d) and 20 months (TTS > 90 d). CCS cancer-specific survival, RFS recurrence-free survival.

Figure 2

Oncological survival in cholangiocarcinoma stratified by time to surgery with respect to tumor type. (A) Cancer-specific in perihilar cholangiocarcinoma. The median CCS was 49 months. (B) Cancer-specific in perihilar cholangiocarcinoma stratified by time to surgery. The median CSS were 76 months (TTS 1–30 d), 39 months (TTS 31–60 d), 83 months (TTS 61–90 d) and 41 months (TTS > 90 d). (C) Recurrence-free survival in perihilar cholangiocarcinoma. The median RFS was 29 months. (D) Recurrence-free survival in perihilar cholangiocarcinoma stratified by time to surgery. The median RFS were 52 months (TTS 1–30 d), 25 months (TTS 31–60 d), 31 months (TTS 61–90 d) and 40 months TTS > 90 d). (E) Cancer-specific in intrahepatic cholangiocarcinoma. The median CCS was 32 months. (F) Cancer-specific in intrahepatic cholangiocarcinoma stratified by time to surgery. The median CSS were 28 months (TTS 1–30 d), 31 months (TTS 31–60 d), 50 months (TTS 61–90 d) and 61 months (TTS > 90 d). (G) Recurrence-free survival in intrahepatic cholangiocarcinoma. The median RFS was 13 months. (H) Recurrence-free survival in intrahepatic cholangiocarcinoma stratified by time to surgery. The median RFS were 11 months (TTS 1–30 d), 15 months (TTS 31–60 d), 17 months (TTS 61–90 d) and 19 months (TTS > 90 d). CCS cancer-specific survival, RFS recurrence-free survival.