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Prognostic Impact of Tumor Multinodularity in Intrahepatic Cholangiocarcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The prognostic value of tumor multinodularity in intrahepatic cholangiocarcinoma (ICC) remains debated. We aimed to evaluate the impact of tumor multinodularity according to the presence and distribution of multiples ICC’s nodules.

Methods

A retrospective review of a prospectively maintained database of patients undergoing resection for ICC from January 1995 to September 2017 was performed. Prognostic factors for survival were assessed by multivariate Cox analysis. Tumoral nodules were defined according to their number (single and multiple) and localization (satellites and contralateral).

Results

Out of 120 selected patients, 64 (53%) had single and 56 (47%) had multiple lesions. Multiple lesions included tumors with satellites (n = 40; 71.5%) and tumors with contralateral lesions (n = 16; 28.5%). Patients with multiple tumors had significantly larger mean main lesion size (p = 0.02), required a higher rate of perioperative transfusion (p = 0.04), had a greater rate of lymph node involvement (p < 0.0001), vascular invasion (p = 0.04), and poor differentiation (p = 0.04) than single tumors. Patients with single tumors experienced a 5-year survival significantly longer (40%) than patients with multiple tumors (14%; p = 0.004). Patients having tumors with satellites had inferior median overall survival and 5-year survival rates (20 months, 7%) compared with patients with contralateral tumors (33.6 months, 29%) (p = 0.09). Multivariable analysis identified tumor multinodularity, morbidity, tumor size < 5 cm, poor differentiation, and lymph node involvement as independent prognostic factors for overall survival.

Conclusions

Tumor multinodularity represents an independent risk factor for survival in ICCs and identifies a category of patients in need of more effective perioperative treatment.

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Authors and Affiliations

  1. Hepato-Pancreato-Biliary Surgery and Liver transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Molière, 67098, Strasbourg, France

    Pietro Addeo, Issam Jedidi, Andrea Locicero, François Faitot, Constantin Oncioiu & Philippe Bachellier

  2. Department of Pathology, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France

    Alina Onea

Authors
  1. Pietro Addeo
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  2. Issam Jedidi
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  3. Andrea Locicero
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  4. François Faitot
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  5. Constantin Oncioiu
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  6. Alina Onea
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  7. Philippe Bachellier
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Contributions

Substantial contributions to the conception or design of the work: PA, IJ, AL, FF, OA, and PB.

Acquisition, analysis, or interpretation of data for the work: PA, IJ, AL, FF, CO, OA, and PB.

Drafting the work or revising it critically for important intellectual content: PA and PB.

Final approval of the version to be published: PA, IJ, AL, FF, CO, OA, and PB.

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: PA, IJ, AL, FF, CO, OA and PB.

Corresponding author

Correspondence to Pietro Addeo.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

This work was presented to the 120th Congress of Association Française de Chirurgie in Paris, 19–21 September 2018.

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Addeo, P., Jedidi, I., Locicero, A. et al. Prognostic Impact of Tumor Multinodularity in Intrahepatic Cholangiocarcinoma. J Gastrointest Surg 23, 1801–1809 (2019). https://doi.org/10.1007/s11605-018-4052-y

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  • DOI: https://doi.org/10.1007/s11605-018-4052-y

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