Analysis of Risk Factors for Recurrence of Distal Bile Duct Cancer without Lymph Node Metastasis after Curative Resection: Is Adjuvant Therapy Really Required?
10.52927/jdcr.2026.14.1.43
- Author:
So Jeong KIM
1
;
Hee Seung LEE
;
Moon Jae CHUNG
;
Jeong Youp PARK
;
Seung Woo PARK
;
Seungmin BANG
Author Information
1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- Publication Type:ORIGINAL ARTICLE
- From:
Journal of Digestive Cancer Research
2026;14(1):43-52
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:The benefits of adjuvant therapy after curative resection (CR) have been demonstrated for bile duct cancer with lymph node (LN) metastasis. However, the putative benefits of adjuvant treatment for bile duct cancer without LN metastasis remain controversial.We aimed to identify recurrence risk factors for distal bile duct cancer (DBC) without LN metastasis following CR and high-risk groups that may benefit from adjuvant treatment.
Methods:We retrospectively analyzed recurrence-related factors of patients who underwent surgical resection for DBC at Yonsei University Severance Hospital from January 2010 to June 2019.
Results:Of 380 DBC cases receiving CR, 248 (62.8%) were pathologically confirmed as free from LN metastasis. The recurrence rates of all cases and LN metastasis-free cases were similar at 52.4% and 46.8%, respectively. Further, distant metastasis and local recurrence were about equally frequent. Involvement of adjacent organs, the presence of an R1 resection margin (cancer cells present microscopically), lymphovascular invasion (LVI), and perineural invasion (PNI) were identified as risk factors for recurrence (R1 margin OR: 1.642, 95% CI: 1.045–2.578, p = 0.031; LVI OR: 2.049, 95% CI: 1.347–3.115, p = 0.001; PNI OR: 1.901, 95% CI: 1.170–3.088, p = 0.009). Overall survival was also significantly reduced in patients with R1 resection margins (p = 0.018), LVI (p < 0.001), or PNI (p = 0.002).
Conclusions:The overall risk of LN-negative DBC recurrence remains high after CR. Aggressive systemic adjuvant treatment and active surveillance are required for patients with R1 resection margins, LVI, or PNI.
