Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma

F Bagante, G Spolverato, M Weiss, S Alexandrescu, HP Marques, L Aldrighetti, SK Maithel, C Pulitano, TW Bauer, F Shen, GA Poultsides, O Soubrane, G Martel, B Groot Koerkamp, Alfredo Guglielmi, E Itaru, TM Pawlik

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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. © 2017 The Society for Surgery of the Alimentary Tract
Original languageEnglish
Pages (from-to)1888-1897
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume21
Issue number11
DOIs
Publication statusPublished - 2017

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    Bagante, F., Spolverato, G., Weiss, M., Alexandrescu, S., Marques, HP., Aldrighetti, L., Maithel, SK., Pulitano, C., Bauer, TW., Shen, F., Poultsides, GA., Soubrane, O., Martel, G., Groot Koerkamp, B., Guglielmi, A., Itaru, E., & Pawlik, TM. (2017). Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma. Journal of Gastrointestinal Surgery, 21(11), 1888-1897. https://doi.org/10.1007/s11605-017-3550-7