World Journal of Surgery

, Volume 42, Issue 3, pp 849–857 | Cite as

Implications of Intrahepatic Cholangiocarcinoma Etiology on Recurrence and Prognosis after Curative-Intent Resection: a Multi-Institutional Study

  • Xu-Feng Zhang
  • Jeffery Chakedis
  • Fabio Bagante
  • Eliza W. Beal
  • Yi Lv
  • Matthew Weiss
  • Irinel Popescu
  • Hugo P. Marques
  • Luca Aldrighetti
  • Shishir K. Maithel
  • Carlo Pulitano
  • Todd W. Bauer
  • Feng Shen
  • George A. Poultsides
  • Oliver Soubrane
  • Guillaume Martel
  • B. Groot Koerkamp
  • Alfredo Guglielmi
  • Endo Itaru
  • Timothy M. PawlikEmail author
Original Scientific Report



We sought to investigate the prognosis of patients following curative-intent surgery for intrahepatic cholangiocarcinoma (ICC) stratified by hepatitis B (HBV-ICC), hepatolithiasis (Stone-ICC), and no identifiable cause (conventional ICC) etiologic subtype.


986 patients with HBV-ICC (n = 201), stone-ICC (n = 103), and conventional ICC (n = 682) who underwent curative-intent resection were identified from a multi-institutional database. Propensity score matching (PSM) was used to mitigate residual bias.


HBV-ICC patients more often had cirrhosis, earlier stage tumors, a mass-forming lesion, well-to-moderate tumor differentiation, and an R0 resection versus stone-ICC or conventional ICC patients. Five-year recurrence-free survival among HBV-ICC and conventional ICC patients was 23.9 and 17.8%, respectively, versus a recurrence-free of only 8.3% among patients with stone-ICC. Similarly, 5-year overall survival among patients with stone-ICC was only 18.3% compared with 48.9 and 38.0% for patients with HBV-ICC and conventional ICC, respectively. On PSM, patients with stone-ICC group had equivalent long-term outcomes as HBV-ICC patients. In contrast, on PSM, stone-ICC patients had a median overall survival of only 18.0 months versus 44.0 months for patients with conventional ICC. Median overall survival after intrahepatic-only recurrence among patients who had stone-ICC (6.0 months) was worse than OS among HBV-ICC (13.0 months) or conventional ICC (12.0 months) (p = 0.006 and p = 0.082, respectively).


While HBV-ICC had a better prognosis on unadjusted analyses, these differences were mitigated on PSM suggesting no stage-for-stage differences in outcomes compared with stone-ICC or conventional ICC. In contrast, patients with stone-ICC had worse long-term outcomes. These data highlight the relative importance of ICC etiology relative to established clinicopathological factors in the prognosis of patients with ICC.



X.-F. Z. was supported in part by the China Scholarship Council.

Compliance with ethical standards

Conflicts of interest

We have no financial or commercial interests to disclose

Supplementary material

268_2017_4199_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 23 kb)


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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Xu-Feng Zhang
    • 1
    • 2
  • Jeffery Chakedis
    • 2
  • Fabio Bagante
    • 3
  • Eliza W. Beal
    • 2
  • Yi Lv
    • 1
  • Matthew Weiss
    • 4
  • Irinel Popescu
    • 5
  • Hugo P. Marques
    • 6
  • Luca Aldrighetti
    • 7
  • Shishir K. Maithel
    • 8
  • Carlo Pulitano
    • 9
  • Todd W. Bauer
    • 10
  • Feng Shen
    • 11
  • George A. Poultsides
    • 12
  • Oliver Soubrane
    • 13
  • Guillaume Martel
    • 14
  • B. Groot Koerkamp
    • 15
  • Alfredo Guglielmi
    • 3
  • Endo Itaru
    • 16
  • Timothy M. Pawlik
    • 2
    Email author
  1. 1.Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and EngineeringThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  2. 2.Department of SurgeryThe Ohio State University, Wexner Medical CenterColumbusUSA
  3. 3.Department of SurgeryUniversity of VeronaVeronaItaly
  4. 4.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA
  5. 5.Department of SurgeryFundeni Clinical InstituteBucharestRomania
  6. 6.Department of SurgeryCurry Cabral HospitalLisbonPortugal
  7. 7.Department of SurgeryOspedale San RaffaeleMilanItaly
  8. 8.Department of SurgeryEmory UniversityAtlantaUSA
  9. 9.Department of SurgeryRoyal Prince Alfred Hospital, University of SydneySydneyAustralia
  10. 10.Department of SurgeryUniversity of VirginiaCharlottesvilleUSA
  11. 11.Department of SurgeryEastern Hepatobiliary Surgery HospitalShanghaiChina
  12. 12.Department of SurgeryStanford UniversityStanfordUSA
  13. 13.Department of Hepatobiliopancreatic Surgery and Liver TransplantationAP-HP, Beaujon HospitalClichyFrance
  14. 14.Division of General Surgery, Department of SurgeryUniversity of OttawaOttawaCanada
  15. 15.Department of SurgeryErasmus University Medical CentreRotterdamNetherlands
  16. 16.Gastroenterological Surgery DivisionYokohama City University School of MedicineYokohamaJapan

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