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Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma

  • Original Article
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Journal of Gastrointestinal Surgery

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.

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Author notes

  1. Fabio Bagante and Gaya Spolverato both authors equally contributed to the manuscript

Authors and Affiliations

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

    Fabio Bagante, Gaya Spolverato & Alfredo Guglielmi

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

    Matthew Weiss

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

    Sorin Alexandrescu

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

    Hugo P. Marques

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

    Luca Aldrighetti

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

    Shishir K. Maithel

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

    Carlo Pulitano

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

    Todd W. Bauer

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

    Feng Shen

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

    George A. Poultsides

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

    Oliver Soubrane

  12. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel

  13. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands

    B. Groot Koerkamp

  14. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan

    Endo Itaru

  15. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Timothy M. Pawlik

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  1. Fabio Bagante
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  2. Gaya Spolverato
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  7. Shishir K. Maithel
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  10. Feng Shen
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  11. George A. Poultsides
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  12. Oliver Soubrane
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  15. Alfredo Guglielmi
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  17. Timothy M. Pawlik
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Corresponding author

Correspondence to Timothy M. Pawlik.

Additional information

Presented as an Oral Presentation at the Annual Americas Hepato-Pancreato-Biliary Association Meeting, Miami, FL 2017.

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Bagante, F., Spolverato, G., Weiss, M. et al. Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma. J Gastrointest Surg 21, 1888–1897 (2017). https://doi.org/10.1007/s11605-017-3550-7

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