Skip to main content
SpringerLink
Log in

Recurrent Intrahepatic Cholangiocarcinoma: A 10-Point Score to Predict Post-Recurrence Survival and Guide Treatment of Recurrence

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

Abstract

Introduction

Although up to 50–70% of patients with intrahepatic cholangiocarcinoma (ICC) recur following resection, data to predict post-recurrence survival (PRS) and guide treatment of recurrence are limited.

Methods

Patients who underwent resection of ICC between 2000 and 2020 were identified from an international, multi-institutional database. Data on primary disease as well as laboratory and radiologic data on recurrent disease were collected. Factors associated with PRS were examined and a novel scoring system to predict PRS (PRS score) was developed and internally validated.

Results

Among 986 individuals who underwent resection for ICC, 588 (59.6%) patients developed recurrence at a median follow up of 20.3 months. Among patients who experienced a recurrence, 97 (16.5%) underwent re-resection/ablation for recurrent ICC; 88 (15.0%) and 403 (68.5%) patients received intra-arterial treatment or systemic chemotherapy/supportive therapy, respectively. Patient American Society of Anesthesiologists (ASA) class > 2 (1 point), primary tumor N1/Nx status (1 point), primary R1 resection margin (1 point), primary tumor G3/G4 grade (1 point), carbohydrate antigen (CA) 19-9 > 37 UI/mL (2 points) at recurrence and carcinoembryonic antigen (CEA) > 5 ng/mL (2 points) at recurrence, as well as recurrent bilateral disease (1 point) and early recurrence (1 point) were included in the PRS score. The PRS score successfully stratified patients relative to PRS and demonstrated strong discriminatory ability (C-index 0.70, 95% confidence interval 0.68–0.72). While a PRS score of 0–3 was associated with a 3-year PRS of 62.5% following resection/ablation for recurrent ICC, a PRS score > 3 was associated with a low 3-year PRS of 35.5% (p = 0.03).

Conclusions

The PRS score demonstrated strong discriminatory ability to predict PRS among patients who had developed recurrence following initial resection of ICC. The PRS score may be a useful tool to guide treatment among patients with recurrent ICC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Singal AK, Vauthey JN, Grady JJ, Stroehlein JR. Intra-hepatic cholangiocarcinoma–frequency and demographic patterns: thirty-year data from the M.D. Anderson Cancer Center. J Cancer Res Clin Oncol. 2011;137(7):1071–8.

    Article  PubMed  Google Scholar 

  2. Wu L, Tsilimigras DI, Paredes AZ, et al. Trends in the incidence, treatment and outcomes of patients with intrahepatic cholangiocarcinoma in the USA: facility type is associated with margin status, use of lymphadenectomy and overall survival. World J Surg. 2019;43(7):1777–87.

    Article  PubMed  Google Scholar 

  3. Mavros MN, Economopoulos KP, Alexiou VG, Pawlik TM. Treatment and Prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis. JAMA Surg. 2014;149(6):565–74.

    Article  PubMed  Google Scholar 

  4. Benson AB, D’Angelica MI, Abrams T, et al. NCCN guidelines(R) insights: biliary tract cancers, version 2.2023. J Natl Compr Cancer Netw. 2023;21(7):694–704.

    Article  CAS  Google Scholar 

  5. Tsilimigras DI, Sahara K, Wu L, et al. Very early recurrence after liver resection for intrahepatic cholangiocarcinoma: considering alternative treatment approaches. JAMA Surg. 2020;155(9):823–31.

    Article  PubMed  Google Scholar 

  6. European Association for the Study of the Liver. Electronic address EEE, European Association for the Study of the L. EASL-ILCA Clinical Practice Guidelines on the management of intrahepatic cholangiocarcinoma. J Hepatol. 2023;79(1):181–208.

    Article  Google Scholar 

  7. Tsilimigras DI, Moris D, Mehta R, et al. The systemic immune-inflammation index predicts prognosis in intrahepatic cholangiocarcinoma: an international multi-institutional analysis. HPB (Oxford). 2020;22(12):1667–74.

    Article  PubMed  Google Scholar 

  8. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12(5):351–5.

    Article  PubMed  Google Scholar 

  9. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA A Cancer J Clin. 2017;67(2):93–9.

    Article  Google Scholar 

  10. de Jong MC, Nathan H, Sotiropoulos GC, et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol. 2011;29(23):3140–5.

    Article  PubMed  Google Scholar 

  11. Endo I, Gonen M, Yopp AC, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg. 2008;248(1):84–96.

    Article  PubMed  Google Scholar 

  12. Maithel SK, Gamblin TC, Kamel I, Corona-Villalobos CP, Thomas M, Pawlik TM. Multidisciplinary approaches to intrahepatic cholangiocarcinoma. Cancer. 2013;119(22):3929–42.

    Article  PubMed  Google Scholar 

  13. Spolverato G, Vitale A, Cucchetti A, et al. Can hepatic resection provide a long-term cure for patients with intrahepatic cholangiocarcinoma? Cancer. 2015;121(22):3998–4006.

    Article  PubMed  Google Scholar 

  14. Yuan ZB, Fang HB, Feng QK, Li T, Li J. Prognostic factors of recurrent intrahepatic cholangiocarcinoma after hepatectomy: a retrospective study. World J Gastroenterol. 2022;28(15):1574–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ohira M, Kobayashi T, Hashimoto M, et al. Prognostic factors in patients with recurrent intrahepatic cholangiocarcinoma after curative resection: a retrospective cohort study. Int J Surg. 2018;54(Pt A):156–62.

    Article  PubMed  Google Scholar 

  16. Si A, Li J, Xing X, et al. Effectiveness of repeat hepatic resection for patients with recurrent intrahepatic cholangiocarcinoma: factors associated with long-term outcomes. Surgery. 2017;161(4):897–908.

    Article  PubMed  Google Scholar 

  17. Bartsch F, Eberhard J, Ruckert F, et al. Repeated resection for recurrent intrahepatic cholangiocarcinoma: a retrospective German multicentre study. Liver Int. 2021;41(1):180–91.

    Article  PubMed  Google Scholar 

  18. Nickkholgh A, Ghamarnejad O, Khajeh E, et al. Outcome after liver resection for primary and recurrent intrahepatic cholangiocarcinoma. BJS Open. 2019;3(6):793–801.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Spolverato G, Kim Y, Alexandrescu S, et al. Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative-intent surgical resection. Ann Surg Oncol. 2016;23(1):235–43.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

No sources of funding were used to assist in the preparation of this work.

Author information

Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Diamantis I. Tsilimigras MD, Yutaka Endo MD, PhD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA

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

    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

    Irinel Popescu 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

Authors
  1. Diamantis I. Tsilimigras MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yutaka Endo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alfredo Guglielmi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luca Aldrighetti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew Weiss MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Todd W. Bauer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Irinel Popescu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. George A. Poultsides MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shishir K. Maithel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hugo P. Marques MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Guillaume Martel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Carlo Pulitano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Feng Shen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. François Cauchy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Bas Groot Koerkamp MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Itaru Endo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Timothy M. Pawlik MD, PhD, MPH, MTS, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy M. Pawlik MD, PhD, MPH, MTS, MBA.

Ethics declarations

Disclosures

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This work was accepted as an E-Poster at the Society of Surgical Oncology (SSO) 2024 Annual Meeting, Atlanta, GA, USA.

Supplementary Information

Below is the link to the electronic supplementary material.

10434_2024_15210_MOESM1_ESM.pdf

Online Resource Fig. 1 Violin plot of recurrent disease treatment allocation relative to PRS score. The hollow dot represents the median value, the gray box represents the IQR, while gray lines indicate the minimum and maximum values. The width represents the frequency of observations. PRS Post-recurrence score, IQR Interquartile range (PDF 68 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsilimigras, D.I., Endo, Y., Guglielmi, A. et al. Recurrent Intrahepatic Cholangiocarcinoma: A 10-Point Score to Predict Post-Recurrence Survival and Guide Treatment of Recurrence. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15210-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1245/s10434-024-15210-2

Keywords

Search

Navigation