{
  "abstract": "Objectives: The long-term impact of neoadjuvant chemotherapy (NAC) based on anatomical resectability for perihilar cholangiocarcinoma (PHC) remains unclear. We evaluated the mature long-term outcomes of our multidisciplinary treatment strategy based on anatomical resectability classification and regional lymph node (LN) status using gemcitabine plus S-1 (NAC-GS). Methods: Between September 2010 and August 2021, 110 consecutive PHC patients were classified as resectable (R; n = 47), borderline resectable (BR; n = 38), or unresectable locally advanced (UR-LA; n = 25) according to our anatomical resectability classification. NAC-GS was administered to patients with clinically positive LN metastasis and to BR and UR-LA patients. Long-term overall survival (OS), recurrence-free survival (RFS), and prognostic factors were evaluated. Results: NAC-GS was administered to 72 patients (65.5%). Curative-intent resection was achieved in 40 (85.1%), 25 (65.8%), and 6 (24.0%) patients in the R, BR, and UR-LA groups, respectively. In the overall cohort, anatomical resectability significantly stratified OS (p = 0.032). However, among patients who underwent curative-intent resection, OS and RFS were comparable across the three resectability groups. Those receiving NAC-GS showed favorable long-term survival despite having more advanced disease characteristics; however, this comparison was limited to selected patients who ultimately proceeded to surgery. Multivariable analysis identified preoperative serum carcinoembryonic antigen ≥5.5 ng/mL (HR: 3.174, p = 0.003), non-adjuvant therapy (HR: 2.222, p = 0.023) and pathological T4 (HR: 2.397, p = 0.037) as independent predictors of poor survival. Conclusions: Anatomical resectability was associated with long-term prognosis and the likelihood of achieving curative-intent resection. Selected patients who ultimately underwent curative-intent resection after NAC-GS showed favorable long-term outcomes; however, these findings do not establish a survival benefit of NAC-GS over upfront surgery. Prospective multi-institutional validation is warranted.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu 5148507, Japan"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Naohisa Kuriyama",
      "orcid": "0000-0002-9668-0500"
    },
    {
      "affs": [
        0
      ],
      "name": "Shugo Mizuno",
      "orcid": "0000-0002-2253-544X"
    },
    {
      "affs": [
        0
      ],
      "name": "Yuki Segi"
    },
    {
      "affs": [
        0
      ],
      "name": "Haruna Komatusbara",
      "orcid": "0009-0008-6856-4992"
    },
    {
      "affs": [
        0
      ],
      "name": "Kazuyuki Gyoten"
    },
    {
      "affs": [
        0
      ],
      "name": "Takahiro Ito",
      "orcid": "0000-0002-1876-3052"
    },
    {
      "affs": [
        0
      ],
      "name": "Aoi Hayasaki"
    },
    {
      "affs": [
        0
      ],
      "name": "Takehiro Fujii"
    },
    {
      "affs": [
        0
      ],
      "name": "Yusuke Iizawa"
    },
    {
      "affs": [
        0
      ],
      "name": "Yasuhiro Murata"
    },
    {
      "affs": [
        0
      ],
      "name": "Akihiro Tanemura"
    },
    {
      "affs": [
        0
      ],
      "name": "Masashi Kishiwada",
      "orcid": "0000-0003-4408-2960"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/e2gj3yb2h7a9v.bib",
  "cited_by": 0,
  "doi": "10.3390/cancers18193238",
  "fulltext_url": null,
  "id": "e2gj3yb2h7a9v",
  "issns": [
    "2072-6694"
  ],
  "landing_url": "https://www.mdpi.com/2072-6694/18/19/3238",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Cholangiocarcinoma and Gallbladder Cancer Studies"
    ]
  ],
  "openalex": "W7220995612",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-08",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/e2gj3yb2h7a9v.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:58Z",
      "native_id": "10.3390/cancers18193238",
      "source": "crossref",
      "url": "https://www.mdpi.com/2072-6694/18/19/3238"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Cholangiocarcinoma and Gallbladder Cancer Studies",
      "subfield": "surgery"
    }
  ],
  "title": "Long-Term Outcomes of a Multidisciplinary Treatment Strategy Using Neoadjuvant Gemcitabine Plus S-1 Based on Anatomical Resectability Classification and Lymph Node Status in Patients with Perihilar Cholangiocarcinoma",
  "title_text": "Long-Term Outcomes of a Multidisciplinary Treatment Strategy Using Neoadjuvant Gemcitabine Plus S-1 Based on Anatomical Resectability Classification and Lymph Node Status in Patients with Perihilar Cholangiocarcinoma",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:58Z",
  "url": "https://research.draconitic.com/paper/e2gj3yb2h7a9v",
  "venue": "Cancers",
  "versions": []
}