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
- 1Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu 5148507, Japan
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.
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BibTeX
@article{kuriyama2026longterm,
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}},
author = {Naohisa Kuriyama and Shugo Mizuno and Yuki Segi and Haruna Komatusbara and Kazuyuki Gyoten and Takahiro Ito and Aoi Hayasaki and Takehiro Fujii and Yusuke Iizawa and Yasuhiro Murata and Akihiro Tanemura and Masashi Kishiwada},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18193238},
url = {https://www.mdpi.com/2072-6694/18/19/3238},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Naohisa Kuriyama
AU - Shugo Mizuno
AU - Yuki Segi
AU - Haruna Komatusbara
AU - Kazuyuki Gyoten
AU - Takahiro Ito
AU - Aoi Hayasaki
AU - Takehiro Fujii
AU - Yusuke Iizawa
AU - Yasuhiro Murata
AU - Akihiro Tanemura
AU - Masashi Kishiwada
PY - 2026
DA - 2026/10/08
JO - Cancers
DO - 10.3390/cancers18193238
UR - https://www.mdpi.com/2072-6694/18/19/3238
AB - 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.
SN - 2072-6694
ER -