Intrahepatic cholangiocarcinoma: An international multi-institutional analysis of prognostic factors and lymph node assessment

Mechteld C. De Jong, Hari Nathan, Georgios C. Sotiropoulos, Andreas Paul, Sorin Alexandrescu, Hugo Marques, Carlo Pulitano, Eduardo Barroso, Bryan M. Clary, Luca Aldrighetti, Cristina R. Ferrone, Andrew X. Zhu, Todd W. Bauer, Dustin M. Walters, T. Clark Gamblin, Kevin T. Nguyen, Ryan Turley, Irinel Popescu, Catherine Hubert, Stephanie MeyerRichard D. Schulick, Michael A. Choti, Jean Francois Gigot, Gilles Mentha, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Purpose: To identify factors associated with outcome after surgical management of intrahepatic cholangiocarcinoma (ICC) and examine the impact of lymph node (LN) assessment on survival. Patients and Methods: From an international multi-institutional database, 449 patients who underwent surgery for ICC between 1973 and 2010 were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses. Results: Median tumor size was 6.5 cm. Most patients had a solitary tumor (73%) and no vascular invasion (69%). Median survival was 27 months, and 5-year survival was 31%. Factors associated with adverse prognosis included positive margin status (hazard ratio [HR], 2.20; P <.001), multiple lesions (HR, 1.80; P = .001), and vascular invasion (HR, 1.59; P = .015). Tumor size was not a prognostic factor (HR, 1.03; P = .23). Patients were stratified using the American Joint Committee on Cancer/International Union Against Cancer T1, T2a, and T2b categories (seventh edition) in a discrete step-wise fashion (P <.001). Lymphadenectomy was performed in 248 patients (55%); 74 of these (30%) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0, 30 months v N1, 24 months; P = .03). Although patients with no LN metastasis were able to be stratified by tumor number and vascular invasion (N0; P <.001), among patients with N1 disease, multiple tumors and vascular invasion, either alone or together, failed to discriminate patients into discrete prognostic groups (P = .34). Conclusion: Although tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. N1 status adversely affected overall survival and also influenced the relative effect of tumor number and vascular invasion on prognosis. Lymphadenectomy should be strongly considered for ICC, because up to 30% of patients will have LN metastasis.

Original languageEnglish
Pages (from-to)3140-3145
Number of pages6
JournalJournal of Clinical Oncology
Volume29
Issue number23
DOIs
Publication statusPublished - Aug 10 2011

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Cholangiocarcinoma
Lymph Nodes
Blood Vessels
Neoplasms
Survival
Neoplasm Metastasis
Lymph Node Excision
Pyridinolcarbamate
Multivariate Analysis
Databases

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

De Jong, M. C., Nathan, H., Sotiropoulos, G. C., Paul, A., Alexandrescu, S., Marques, H., ... Pawlik, T. M. (2011). Intrahepatic cholangiocarcinoma: An international multi-institutional analysis of prognostic factors and lymph node assessment. Journal of Clinical Oncology, 29(23), 3140-3145. https://doi.org/10.1200/JCO.2011.35.6519

Intrahepatic cholangiocarcinoma : An international multi-institutional analysis of prognostic factors and lymph node assessment. / De Jong, Mechteld C.; Nathan, Hari; Sotiropoulos, Georgios C.; Paul, Andreas; Alexandrescu, Sorin; Marques, Hugo; Pulitano, Carlo; Barroso, Eduardo; Clary, Bryan M.; Aldrighetti, Luca; Ferrone, Cristina R.; Zhu, Andrew X.; Bauer, Todd W.; Walters, Dustin M.; Gamblin, T. Clark; Nguyen, Kevin T.; Turley, Ryan; Popescu, Irinel; Hubert, Catherine; Meyer, Stephanie; Schulick, Richard D.; Choti, Michael A.; Gigot, Jean Francois; Mentha, Gilles; Pawlik, Timothy M.

In: Journal of Clinical Oncology, Vol. 29, No. 23, 10.08.2011, p. 3140-3145.

Research output: Contribution to journalArticle

De Jong, MC, Nathan, H, Sotiropoulos, GC, Paul, A, Alexandrescu, S, Marques, H, Pulitano, C, Barroso, E, Clary, BM, Aldrighetti, L, Ferrone, CR, Zhu, AX, Bauer, TW, Walters, DM, Gamblin, TC, Nguyen, KT, Turley, R, Popescu, I, Hubert, C, Meyer, S, Schulick, RD, Choti, MA, Gigot, JF, Mentha, G & Pawlik, TM 2011, 'Intrahepatic cholangiocarcinoma: An international multi-institutional analysis of prognostic factors and lymph node assessment', Journal of Clinical Oncology, vol. 29, no. 23, pp. 3140-3145. https://doi.org/10.1200/JCO.2011.35.6519
De Jong, Mechteld C. ; Nathan, Hari ; Sotiropoulos, Georgios C. ; Paul, Andreas ; Alexandrescu, Sorin ; Marques, Hugo ; Pulitano, Carlo ; Barroso, Eduardo ; Clary, Bryan M. ; Aldrighetti, Luca ; Ferrone, Cristina R. ; Zhu, Andrew X. ; Bauer, Todd W. ; Walters, Dustin M. ; Gamblin, T. Clark ; Nguyen, Kevin T. ; Turley, Ryan ; Popescu, Irinel ; Hubert, Catherine ; Meyer, Stephanie ; Schulick, Richard D. ; Choti, Michael A. ; Gigot, Jean Francois ; Mentha, Gilles ; Pawlik, Timothy M. / Intrahepatic cholangiocarcinoma : An international multi-institutional analysis of prognostic factors and lymph node assessment. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 23. pp. 3140-3145.
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abstract = "Purpose: To identify factors associated with outcome after surgical management of intrahepatic cholangiocarcinoma (ICC) and examine the impact of lymph node (LN) assessment on survival. Patients and Methods: From an international multi-institutional database, 449 patients who underwent surgery for ICC between 1973 and 2010 were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses. Results: Median tumor size was 6.5 cm. Most patients had a solitary tumor (73{\%}) and no vascular invasion (69{\%}). Median survival was 27 months, and 5-year survival was 31{\%}. Factors associated with adverse prognosis included positive margin status (hazard ratio [HR], 2.20; P <.001), multiple lesions (HR, 1.80; P = .001), and vascular invasion (HR, 1.59; P = .015). Tumor size was not a prognostic factor (HR, 1.03; P = .23). Patients were stratified using the American Joint Committee on Cancer/International Union Against Cancer T1, T2a, and T2b categories (seventh edition) in a discrete step-wise fashion (P <.001). Lymphadenectomy was performed in 248 patients (55{\%}); 74 of these (30{\%}) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0, 30 months v N1, 24 months; P = .03). Although patients with no LN metastasis were able to be stratified by tumor number and vascular invasion (N0; P <.001), among patients with N1 disease, multiple tumors and vascular invasion, either alone or together, failed to discriminate patients into discrete prognostic groups (P = .34). Conclusion: Although tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. N1 status adversely affected overall survival and also influenced the relative effect of tumor number and vascular invasion on prognosis. Lymphadenectomy should be strongly considered for ICC, because up to 30{\%} of patients will have LN metastasis.",
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T1 - Intrahepatic cholangiocarcinoma

T2 - An international multi-institutional analysis of prognostic factors and lymph node assessment

AU - De Jong, Mechteld C.

AU - Nathan, Hari

AU - Sotiropoulos, Georgios C.

AU - Paul, Andreas

AU - Alexandrescu, Sorin

AU - Marques, Hugo

AU - Pulitano, Carlo

AU - Barroso, Eduardo

AU - Clary, Bryan M.

AU - Aldrighetti, Luca

AU - Ferrone, Cristina R.

AU - Zhu, Andrew X.

AU - Bauer, Todd W.

AU - Walters, Dustin M.

AU - Gamblin, T. Clark

AU - Nguyen, Kevin T.

AU - Turley, Ryan

AU - Popescu, Irinel

AU - Hubert, Catherine

AU - Meyer, Stephanie

AU - Schulick, Richard D.

AU - Choti, Michael A.

AU - Gigot, Jean Francois

AU - Mentha, Gilles

AU - Pawlik, Timothy M.

PY - 2011/8/10

Y1 - 2011/8/10

N2 - Purpose: To identify factors associated with outcome after surgical management of intrahepatic cholangiocarcinoma (ICC) and examine the impact of lymph node (LN) assessment on survival. Patients and Methods: From an international multi-institutional database, 449 patients who underwent surgery for ICC between 1973 and 2010 were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses. Results: Median tumor size was 6.5 cm. Most patients had a solitary tumor (73%) and no vascular invasion (69%). Median survival was 27 months, and 5-year survival was 31%. Factors associated with adverse prognosis included positive margin status (hazard ratio [HR], 2.20; P <.001), multiple lesions (HR, 1.80; P = .001), and vascular invasion (HR, 1.59; P = .015). Tumor size was not a prognostic factor (HR, 1.03; P = .23). Patients were stratified using the American Joint Committee on Cancer/International Union Against Cancer T1, T2a, and T2b categories (seventh edition) in a discrete step-wise fashion (P <.001). Lymphadenectomy was performed in 248 patients (55%); 74 of these (30%) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0, 30 months v N1, 24 months; P = .03). Although patients with no LN metastasis were able to be stratified by tumor number and vascular invasion (N0; P <.001), among patients with N1 disease, multiple tumors and vascular invasion, either alone or together, failed to discriminate patients into discrete prognostic groups (P = .34). Conclusion: Although tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. N1 status adversely affected overall survival and also influenced the relative effect of tumor number and vascular invasion on prognosis. Lymphadenectomy should be strongly considered for ICC, because up to 30% of patients will have LN metastasis.

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