Pancreatic Invasion in Distal Cholangiocarcinoma Is a Poor Prognostic Factor: A New Approach Integrating Tumor Depth of Invasion.

Authors

Hirokazu Ogasawara, Tadashi Yoshizawa, Kenta Ogasawara, Daiki Kasai, Shintaro Goto, Hayato Nagase, Norihisa Kimura, Keinosuke Ishido, Hiroshi Kijima, Kenichi Hakamada

Published in

ANZ journal of surgery. Oct 16, 2026. Epub Oct 16, 2026.

Abstract

The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for distal cholangiocarcinoma (dCCA) uses depth of invasion (DOI) for T classification; however, it does not consider invasion into adjacent organs such as the pancreas. We investigated the prognostic significance of DOI and pancreatic invasion in patients with dCCA.
We retrospectively analyzed 130 patients with dCCA who underwent pancreatoduodenectomy between 2003 and 2016. The optimal DOI cutoff for predicting overall survival (OS) was determined using time-dependent receiver operating characteristic analysis. Associations between clinicopathological factors, pancreatic invasion, and prognosis were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models.
The optimal DOI cutoff for OS was 4 mm. Patients with DOI > 4 mm had significantly poorer survival than those with DOI ≤ 4 mm (p < 0.0001). Pancreatic invasion was associated with worse prognosis (p < 0.001) and was more prevalent in tumors with greater DOI. Among patients with DOI > 4 mm, pancreatic invasion significantly worsened OS (p < 0.05), whereas no prognostic impact was observed in patients with DOI ≤ 4 mm. Multivariate analysis identified the combination of DOI > 4 mm and pancreatic invasion, lymph node metastasis, histological type, and positive resection margin as independent adverse prognostic factors. A novel classification incorporating DOI, pancreatic invasion, and lymph node status provided improved prognostic stratification.
The combination of DOI > 4 mm and pancreatic invasion is an independent predictor of poor prognosis in dCCA. Incorporating pancreatic invasion into DOI-based classification may improve prognostic assessment beyond the current AJCC staging system.

PMID:
42888039
Bibliographic data and abstract were imported from PubMed on 17 Oct 2026.

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