Abstract
Background
The surgical outcome and prognostic factors of intrahepatic cholangiocarcinoma are not fully understood. This study aimed to establish the clinical significance of cirrhosis for prognosis in patients with intrahepatic cholangiocarcinoma after surgery.
Methods
One hundred fifteen patients with intrahepatic cholangiocarcinoma who underwent surgical resection between December 2001 and January 2008 were retrospectively analyzed. The prognostic significance of clinicopathologic factors including cirrhosis was assessed by univariate and multivariate analyses.
Results
Thirty-two of the 115 patients (28%) had liver cirrhosis. Complete tumor removal (R0 resection) was performed in 42 patients (75%). Overall median survival time was 21 months, with 1-, 3-, and 5-year actuarial survival rates of 68%, 27%, and 17%, respectively. There was a significant difference in survival between patients with cirrhosis and those without cirrhosis (P = 0.027). Univariate analysis showed that cirrhosis, vascular invasion, hepatic duct invasion, lymph node metastasis, positive surgical margin (R1), and TNM stage were significantly associated with poor survival. Multivariate analysis showed that cirrhosis, positive surgical margin, and lymph node metastases were related to survival, with hazard ratios of 2.49, 3.53, and 4.16, respectively.
Conclusions
Cirrhosis is an independent factor for poor prognosis in intrahepatic cholangiocarcinoma after surgery.
Similar content being viewed by others
References
Khan SA, Taylor-Robinson SD, Toledano MB, Beck A, Elliott P, Thomas HC. Changing international trends in mortality rates for liver, biliary and pancreatic tumours. J Hepatol 2002;37:806–813.
Patel T. Worldwide trends in mortality from biliary tract malignancies. BMC Cancer 2002;2:10.
Shaib Y, El-Serag HB. The epidemiology of cholangiocarcinoma. Semin Liver Dis 2004;24:115–125.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics 2002. CA Cancer J Clin 2002;55:74–108.
Hou J, Liu Z, Gu F. epidemiology and prevention of hepatitis B virus infection. Int J Med Sci 2005;2:50–57.
Pausaw asdi A, Watanapa P. Hepatolithiasis: epidemiology and classification. Hepatogastroenterology 1997; 44:314–316.
Chen CC, Yen CH, Wu WY, Hu SW, Chen SC, Bell WR, Lee MC. Epidemiology of hepatitis B virus infection among young adults in Taiwan, China after public vaccination program. Chin Med J (Engl) 2007;120:1155–1158.
Sorensen HT, Friis S, Olsen JH, Thulstrup AM, Mellemkjaer L, Linet M, Trichopoulos D, Vilstrup H, Olsen J.. Risk of liver and other types of cancer in patients with cirrhosis: a nationwide cohort study in Denmark. Hepatology 1998;28:921–925.
Shin HR, Lee CU, Park HJ, Seol SY, Chung JM, Choi HC, Ahn YO, Shigemastu T. Hepatitis B and C virus, Clonorchis sinensis for the risk of liver cancer: a case-control study in Pusan, Korea. Int J Epidemiol 1996; 25:933–940.
Kubo S, Kinoshita H, Hirohashi K, Hamba H. Hepatolithiasis associated with cholangiocarcinoma. World J Surg 1995;19:637–641.
Okuda K, Nakanuma Y, Miyazaki M. Cholangiocarcinoma: recent progress. Part 1: epidemiology and etiology. J Gastroenterol Hepatol 2002;17:1049–1055.
Weber SM, Jarnagin WR, Klimstra D DeMatteo RP, Fong Y, Blumgart LH. Inrahepatic cholangiocarcinoma: resectability, recurrence pattern, and outcomes. J Am Coll Surg 2001;193:384–391.
Uenishi T, Hirohashi K, Kubo S, Yamamoto T, Hamba H, Tanaka H, Kinoshita H. Histological factors affecting prognosis following hepatectomy for intrahepatic cholangiocarcinoma. World J Surg 2001;25:865–869.
Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H, Miyazaki M. Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. Br J Surg 2002;89:1525–1531.
Jarnagin WR, Shoup M. Surgical management of cholangiocarcinoma. Semin Liver Dis 2004;24:189–199.
Barbara L, Benzi G, Gaiani S, Fusconi F, Zironi G, Siringo S, Rigamonti A, Barbara C, Grigioni W, Mazziotti A. Natural history of small untreated hepatocellular carcinoma in cirrhosis: a multivariate analysis of s of tumor growth rate and patient. Hepatology 1992;16:132–137.
Pandey D, Lee KH, Wai CT, Wagholikar G, Tan KC. Long term outcome and prognostic factors for large hepatocellular carcinoma (10 cm or more) after surgical resection. Ann Surg Oncol 2007;14:2817–2823.
Liu P, Yang JM, Niu WY, Kan T, Xie F, Li DQ, Wang Y, Zhou YM. Prognostic factors in the surgical treatment of caudate lobe hepatocellular carcinoma. World J Gastroenterol 2010;16:1123–1128.
Sobin LH, Wittekind CH. TNM classification of malignant tumors, Fifth edition New York: Wiley-Liss, 1997.
Lau H, Man K, Fan ST, Yu WC, Lo CM, Wong J. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg 1997;84:1255–1259.
Terminology Committee of the International Hepato-Pancreato-Biliary Association. Brisbane 2000 Terminology of Liver Anatomy and Resections. Hepatobiliary Pancreat Surg 2000;2:333–339.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240:205–213.
Cappellani A, Malfermoni G, Iacono C. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg 2009;33:1247–1254.
Nakeeb A, Tran KQ, Black MJ, Erickson BA, Ritch PS, Quebbeman EJ, Wilson SD, Demeure MJ, Rilling WS, Dua KS, Pitt HA.. Improved survival in resected biliary malignancies. Surgery 2002;132:555–563.
Lang H, Sotiropoulos GC, Frühauf NR, Dömland M, Paul A, Kind EM, Malagó M, Broelsch CE. Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period. Ann Surg 2005;241:134–143.
Nakagohri T, Kinoshita T, Konishi M, Takahashi S, Gotohda N. Surgical outcome and prognostic factors in intrahepatic cholangiocarcinoma. World J Surg 2008;32:2675–2680.
Shimada K, Sano T, Sakamoto Y, Esaki M, Kosuge T, Ojima H. Clinical impact of the surgical margin status in hepatectomy for solitary massforming type intrahepatic cholangiocarcinoma without lymph node metastases. J Surg Oncol 2007;96:160–165.
Uenishi T, Yamazaki O, Yamamoto T, Hirohashi K, Tanaka H, Tanaka S, Hai S, Kubo S. Serosal invasion in TNM staging of mass-forming intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg 2005;12:479–483.
Nakagawa T, Kamiyama T, Kurauchi N, Matsushita M, Nakanishi K, Kamachi H, Kudo T, Todo S. Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma. World J Surg 2005;29:728–733.
Miwa S, Miyagawa S, Kobayashi A, Akahane Y, Nakata T, Mihara M, Kusama K, Soeda J, Ogawa S. Predictive factors for intrahepatic cholangiocarcinoma recurrence in the liver following surgery. J Gastroenterol 2006;4:893–900.
Suzuki S, Sakaguchi T, Yokoi Y, Okamoto K, Kurachi K, Tsuchiya Y, Okumura T, Konno H, Baba S, Nakamura S. Clinicopathological prognostic factors and impact of surgical treatment of mass-forming intrahepatic cholangiocarcinoma. World J Surg 2002;26:687–693.
Isa T, Kusano T, Shimoji H, Takeshima Y, Muto Y, Furukawa M. Predictive factors for long-term survival in patients with intrahepatic cholangiocarcinoma. Am J Surg 2001;181:507–511.
kai I, Arii S, Ichida T, Okita K, Omata M, Kojiro M, Takayasu K, Nakanuma Y, Makuuchi M, Matsuyama Y, Yamaoka Y. Report of the 16th follow-up survey of primary liver cancer. Hepatol Res 2005; 32:163–172.
Shaib YH, El-Serag HB, Davila JA, Morgan R, McGlynn KA. Risk factors of intrahepatic cholangiocarcinoma in the United States: a case-control study. Gastroenterology 2005;128:620–626.
Zhou YM, Yin ZF, Yang JM, Li B, Shao WY, Xu F, Wang YL, Li DQ. Risk factors for intrahepatic cholangiocarcinoma: A case-control study in China. World J Gastroenterol 2008; 14(4): 632–635.
Zhou HB, Wang H, Zhou DX, Wang H, Wang Q, Zou SS, Hu HP. Etiological and clinicopathologic characteristics of intrahepatic cholangiocarcinoma in young patients. World J Gastroenterol 2010;16(7):881–885.
Conflict of interest
There is no conflict of interest in the study.
Author information
Authors and Affiliations
Corresponding author
Additional information
Ya-yong Li and Hao Li contributed equally to this study and are co-first authors.
Rights and permissions
About this article
Cite this article
Li, Yy., Li, H., Lv, P. et al. Prognostic Value of Cirrhosis for Intrahepatic Cholangiocarcinoma After Surgical Treatment. J Gastrointest Surg 15, 608–613 (2011). https://doi.org/10.1007/s11605-011-1419-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-011-1419-8