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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Cholangiocarcinoma
Survivors
Survival
Liver
Databases
Incidence
Neoplasms

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Bagante, F., Spolverato, G., Weiss, M., Alexandrescu, S., Marques, HP., Aldrighetti, L., ... 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

Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma. / 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, Alfredo; Itaru, E; Pawlik, TM.

In: Journal of Gastrointestinal Surgery, Vol. 21, No. 11, 2017, p. 1888-1897.

Research output: Contribution to journalArticle

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, vol. 21, no. 11, pp. 1888-1897. https://doi.org/10.1007/s11605-017-3550-7
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, Alfredo ; Itaru, E ; Pawlik, TM. / Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma. In: Journal of Gastrointestinal Surgery. 2017 ; Vol. 21, No. 11. pp. 1888-1897.
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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. {\circledC} 2017 The Society for Surgery of the Alimentary Tract",
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T1 - Defining Long-Term Survivors Following Resection of Intrahepatic Cholangiocarcinoma

AU - Bagante, F

AU - Spolverato, G

AU - Weiss, M

AU - Alexandrescu, S

AU - Marques, HP

AU - Aldrighetti, L

AU - Maithel, SK

AU - Pulitano, C

AU - Bauer, TW

AU - Shen, F

AU - Poultsides, GA

AU - Soubrane, O

AU - Martel, G

AU - Groot Koerkamp, B

AU - Guglielmi, Alfredo

AU - Itaru, E

AU - Pawlik, TM

PY - 2017

Y1 - 2017

N2 - 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

AB - 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

U2 - 10.1007/s11605-017-3550-7

DO - 10.1007/s11605-017-3550-7

M3 - Article

VL - 21

SP - 1888

EP - 1897

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

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ER -