3 years ago

Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma

Todd W. Bauer, Hugo P. Marques, Carlo Pulitano, Gaya Spolverato, Timothy M. Pawlik, Fabio Bagante, Guillaume Martel, Endo Itaru, Oliver Soubrane, Sorin Alexandrescu, Luca Aldrighetti, Alfredo Guglielmi, George A. Poultsides, Shishir K. Maithel, B. Groot Koerkamp, Matthew Weiss, Feng Shen

Abstract

Background

Intrahepatic cholangiocarcinoma (ICC) is an aggressive primary tumor of the liver. While surgery remains the cornerstone of therapy, long-term survival following curative-intent resection is generally poor. The aim of the current study was to define the incidence of actual long-term survivors, as well as identify clinicopathological factors associated with long-term survival.

Methods

Patients who underwent a curative-intent liver resection for ICC between 1990 and 2015 were identified using a multi-institutional database. Overall, 679 patients were alive with ≥ 5 years of follow-up or had died during follow-up. Prognostic factors among patients who were long-term survivors (LT) (overall survival (OS) ≥ 5) were compared with patients who were not non-long-term survivors (non-LT) (OS < 5).

Results

Among the 1154 patients who underwent liver resection for ICC, 5- and 10-year OS were 39.6 and 20.3% while the actual LT survival rate was 13.3%. After excluding 475 patients who survived < 5 years, as well as patients were alive yet had < 5 years of follow-up, 153 patients (22.5%) who survived ≥ 5 years were included in the LT group, while 526 patients (77.5%) who died < 5 years from the date of surgery were included in the non-LT group. Factors associated with not surviving to 5 years included perineural invasion (OR 4.78, 95% CI, 1.92–11.8; p = 0.001), intrahepatic metastasis (OR 3.75, 95% CI, 0.85–16.6, p = 0.082), satellite lesions (OR 2.12, 95% CI, 1.15–3.90, p = 0.016), N1 status (OR 4.64, 95% CI, 1.77–12.2; p = 0.002), ICC > 5 cm (OR 2.40, 95% CI, 1.54–3.74, p < 0.001), and direct invasion of an adjacent organ (OR 3.98, 95% CI, 1.18–13.4, p = 0.026). However, a subset of patients (< 10%) who had these pathological characteristics were LT.

Conclusion

While ICC is generally associated with a poor prognosis, some patients will be LT. In fact, even a subset of patients with traditional adverse prognostic factors survived long term.

Publisher URL: https://link.springer.com/article/10.1007/s11605-017-3550-7

DOI: 10.1007/s11605-017-3550-7

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