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The Application of Artificial Intelligence to Investigate Long-Term Outcomes and Assess Optimal Margin Width in Hepatectomy for Intrahepatic Cholangiocarcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Intrahepatic cholangiocarcinoma (ICC) is associated with poor long-term outcomes, and limited evidence exists on optimal resection margin width. This study used artificial intelligence to investigate long-term outcomes and optimal margin width in hepatectomy for ICC.

Methods

The study enrolled patients who underwent curative-intent resection for ICC between 1990 and 2020. The optimal survival tree (OST) was used to investigate overall (OS) and recurrence-free survival (RFS). An optimal policy tree (OPT) assigned treatment recommendations based on random forest (RF) counterfactual survival probabilities associated with each possible margin width between 0 and 20 mm.

Results

Among 600 patients, the median resection margin was 4 mm (interquartile range [IQR], 2–10). Overall, 379 (63.2 %) patients experienced recurrence with a 5-year RFS of 28.3 % and a 5-year OS of 38.7 %. The OST identified five subgroups of patients with different OS rates based on tumor size, a carbohydrate antigen 19-9 [CA19-9] level higher than 200 U/mL, nodal status, margin width, and age (area under the curve [AUC]: training, 0.81; testing, 0.69). The patients with tumors smaller than 4.8 cm and a margin width of 2.5 mm or greater had a relative increase in 5-year OS of 37 % compared with the entire cohort. The OST for RFS estimated a 46 % improvement in the 5-year RFS for the patients younger than 60 years who had small (<4.8 cm) well- or moderately differentiated tumors without microvascular invasion. The OPT suggested five optimal margin widths to maximize the 5-year OS for the subgroups of patients based on age, tumor size, extent of hepatectomy, and CA19-9 levels.

Conclusions

Artificial intelligence OST identified subgroups within ICC relative to long-term outcomes. Although tumor biology dictated prognosis, the OPT suggested that different margin widths based on patient and disease characteristics may optimize ICC long-term survival.

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Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Wexner Medical Center, James Comprehensive Cancer Center, Department of Surgery, The Ohio State University, 395 West 12th Avenue, Suite 670, Columbus, OH, USA

    Laura Alaimo MD, Zorays Moazzam MD, Yutaka Endo MD, PhD, Henrique A. Lima MD, Swatika P. Butey MBBS, Alex Kim MD, Aslam Ejaz MD, Joal Beane MD, Jordan Cloyd MD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

  2. Department of Surgery, University of Verona, Verona, Italy

    Laura Alaimo MD, Andrea Ruzzenente MD, PhD & Alfredo Guglielmi MD

  3. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Luca Aldrighetti MD

  4. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

  5. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD

  6. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Sorin Alexandrescu MD

  7. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides MD

  8. Department of Surgery, Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD

  9. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD

  10. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel MD

  11. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia

    Carlo Pulitano MD

  12. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen MD

  13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France

    François Cauchy MD

  14. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Bas Groot Koerkamp MD

  15. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan

    Itaru Endo MD, PhD

  16. Department of Surgery, Keio University, Tokyo, Japan

    Minoru Kitago MD

Authors
  1. Laura Alaimo MD
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  2. Zorays Moazzam MD
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  3. Yutaka Endo MD, PhD
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  4. Henrique A. Lima MD
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  5. Swatika P. Butey MBBS
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  6. Andrea Ruzzenente MD, PhD
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  7. Alfredo Guglielmi MD
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  8. Luca Aldrighetti MD
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  9. Matthew Weiss MD
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  11. Sorin Alexandrescu MD
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  12. George A. Poultsides MD
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  13. Shishir K. Maithel MD
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  14. Hugo P. Marques MD
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  15. Guillaume Martel MD
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  16. Carlo Pulitano MD
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  17. Feng Shen MD
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  18. François Cauchy MD
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  19. Bas Groot Koerkamp MD
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  20. Itaru Endo MD, PhD
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  21. Minoru Kitago MD
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  22. Alex Kim MD
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  23. Aslam Ejaz MD
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  24. Joal Beane MD
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  25. Jordan Cloyd MD
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  26. Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)
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Corresponding author

Correspondence to Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.).

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Alaimo, L., Moazzam, Z., Endo, Y. et al. The Application of Artificial Intelligence to Investigate Long-Term Outcomes and Assess Optimal Margin Width in Hepatectomy for Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 30, 4292–4301 (2023). https://doi.org/10.1245/s10434-023-13349-y

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  • DOI: https://doi.org/10.1245/s10434-023-13349-y

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