Patterns of Distribution of Hepatic Nodules (Single, Satellites or Multifocal) in Intrahepatic Cholangiocarcinoma: Prognostic Impact After Surgery

Simone Conci, Andrea Ruzzenente, Luca Viganò, Giorgio Ercolani, Andrea Fontana, Fabio Bagante, Francesca Bertuzzo, Andrea Dore, Antonio Daniele Pinna, Guido Torzilli, Calogero Iacono, Alfredo Guglielmi

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: We aimed to compare the clinicopathological features and survival after surgery of patients with intrahepatic cholangiocarcinoma (ICC) according to the patterns of distribution of hepatic nodules.

METHODS: A retrospective analysis of a multi-institutional series of 259 patients with resected ICC was carried out. Patients were further classified according to the pattern of distribution of hepatic nodules: single tumors (type I), single tumors with satellites in the same liver segment (type II), or multifocal tumors (type III).

RESULTS: Overall, 64.5% of patients had type I, 21.9% had type II, and 13.5% had type III. The 5-year overall survival rate was 49.4, 34.2, and 9.9% for types I, II, and III, respectively (p < 0.001). A multivariate survival analysis identified the following independent prognostic factors: pattern types II and III (p = 0.001 and p = 0.001, respectively), size ≥ 50 mm (p = 0.021), lymph node (LN) metastases (p = 0.005), and R1 resections (p = 0.019). We stratified survival for each type of pattern according to the other prognostic factors identified in the multivariate analysis. N0 and R0 patients with type II and III tumors had encouraging long-term results. Conversely, patients with LN metastases and R1 resections had poor prognosis, particularly patients with type III tumors.

CONCLUSION: ICC has distinct patterns of distribution with different prognoses that should be considered when making therapeutic decisions. Patients with type III tumors had a significantly worse prognosis, and the benefits of upfront surgery should be carefully evaluated.

Original languageEnglish
Pages (from-to)3719-3727
Number of pages9
JournalAnnals of Surgical Oncology
Volume25
Issue number12
DOIs
Publication statusPublished - Nov 2018

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Cholangiocarcinoma
Liver
Neoplasms
Multivariate Analysis
Lymph Nodes
Neoplasm Metastasis
Survival
Survival Analysis
Decision Making
Survival Rate

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Patterns of Distribution of Hepatic Nodules (Single, Satellites or Multifocal) in Intrahepatic Cholangiocarcinoma : Prognostic Impact After Surgery. / Conci, Simone; Ruzzenente, Andrea; Viganò, Luca; Ercolani, Giorgio; Fontana, Andrea; Bagante, Fabio; Bertuzzo, Francesca; Dore, Andrea; Pinna, Antonio Daniele; Torzilli, Guido; Iacono, Calogero; Guglielmi, Alfredo.

In: Annals of Surgical Oncology, Vol. 25, No. 12, 11.2018, p. 3719-3727.

Research output: Contribution to journalArticle

Conci, S, Ruzzenente, A, Viganò, L, Ercolani, G, Fontana, A, Bagante, F, Bertuzzo, F, Dore, A, Pinna, AD, Torzilli, G, Iacono, C & Guglielmi, A 2018, 'Patterns of Distribution of Hepatic Nodules (Single, Satellites or Multifocal) in Intrahepatic Cholangiocarcinoma: Prognostic Impact After Surgery', Annals of Surgical Oncology, vol. 25, no. 12, pp. 3719-3727. https://doi.org/10.1245/s10434-018-6669-1
Conci, Simone ; Ruzzenente, Andrea ; Viganò, Luca ; Ercolani, Giorgio ; Fontana, Andrea ; Bagante, Fabio ; Bertuzzo, Francesca ; Dore, Andrea ; Pinna, Antonio Daniele ; Torzilli, Guido ; Iacono, Calogero ; Guglielmi, Alfredo. / Patterns of Distribution of Hepatic Nodules (Single, Satellites or Multifocal) in Intrahepatic Cholangiocarcinoma : Prognostic Impact After Surgery. In: Annals of Surgical Oncology. 2018 ; Vol. 25, No. 12. pp. 3719-3727.
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abstract = "OBJECTIVE: We aimed to compare the clinicopathological features and survival after surgery of patients with intrahepatic cholangiocarcinoma (ICC) according to the patterns of distribution of hepatic nodules.METHODS: A retrospective analysis of a multi-institutional series of 259 patients with resected ICC was carried out. Patients were further classified according to the pattern of distribution of hepatic nodules: single tumors (type I), single tumors with satellites in the same liver segment (type II), or multifocal tumors (type III).RESULTS: Overall, 64.5{\%} of patients had type I, 21.9{\%} had type II, and 13.5{\%} had type III. The 5-year overall survival rate was 49.4, 34.2, and 9.9{\%} for types I, II, and III, respectively (p < 0.001). A multivariate survival analysis identified the following independent prognostic factors: pattern types II and III (p = 0.001 and p = 0.001, respectively), size ≥ 50 mm (p = 0.021), lymph node (LN) metastases (p = 0.005), and R1 resections (p = 0.019). We stratified survival for each type of pattern according to the other prognostic factors identified in the multivariate analysis. N0 and R0 patients with type II and III tumors had encouraging long-term results. Conversely, patients with LN metastases and R1 resections had poor prognosis, particularly patients with type III tumors.CONCLUSION: ICC has distinct patterns of distribution with different prognoses that should be considered when making therapeutic decisions. Patients with type III tumors had a significantly worse prognosis, and the benefits of upfront surgery should be carefully evaluated.",
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TY - JOUR

T1 - Patterns of Distribution of Hepatic Nodules (Single, Satellites or Multifocal) in Intrahepatic Cholangiocarcinoma

T2 - Prognostic Impact After Surgery

AU - Conci, Simone

AU - Ruzzenente, Andrea

AU - Viganò, Luca

AU - Ercolani, Giorgio

AU - Fontana, Andrea

AU - Bagante, Fabio

AU - Bertuzzo, Francesca

AU - Dore, Andrea

AU - Pinna, Antonio Daniele

AU - Torzilli, Guido

AU - Iacono, Calogero

AU - Guglielmi, Alfredo

PY - 2018/11

Y1 - 2018/11

N2 - OBJECTIVE: We aimed to compare the clinicopathological features and survival after surgery of patients with intrahepatic cholangiocarcinoma (ICC) according to the patterns of distribution of hepatic nodules.METHODS: A retrospective analysis of a multi-institutional series of 259 patients with resected ICC was carried out. Patients were further classified according to the pattern of distribution of hepatic nodules: single tumors (type I), single tumors with satellites in the same liver segment (type II), or multifocal tumors (type III).RESULTS: Overall, 64.5% of patients had type I, 21.9% had type II, and 13.5% had type III. The 5-year overall survival rate was 49.4, 34.2, and 9.9% for types I, II, and III, respectively (p < 0.001). A multivariate survival analysis identified the following independent prognostic factors: pattern types II and III (p = 0.001 and p = 0.001, respectively), size ≥ 50 mm (p = 0.021), lymph node (LN) metastases (p = 0.005), and R1 resections (p = 0.019). We stratified survival for each type of pattern according to the other prognostic factors identified in the multivariate analysis. N0 and R0 patients with type II and III tumors had encouraging long-term results. Conversely, patients with LN metastases and R1 resections had poor prognosis, particularly patients with type III tumors.CONCLUSION: ICC has distinct patterns of distribution with different prognoses that should be considered when making therapeutic decisions. Patients with type III tumors had a significantly worse prognosis, and the benefits of upfront surgery should be carefully evaluated.

AB - OBJECTIVE: We aimed to compare the clinicopathological features and survival after surgery of patients with intrahepatic cholangiocarcinoma (ICC) according to the patterns of distribution of hepatic nodules.METHODS: A retrospective analysis of a multi-institutional series of 259 patients with resected ICC was carried out. Patients were further classified according to the pattern of distribution of hepatic nodules: single tumors (type I), single tumors with satellites in the same liver segment (type II), or multifocal tumors (type III).RESULTS: Overall, 64.5% of patients had type I, 21.9% had type II, and 13.5% had type III. The 5-year overall survival rate was 49.4, 34.2, and 9.9% for types I, II, and III, respectively (p < 0.001). A multivariate survival analysis identified the following independent prognostic factors: pattern types II and III (p = 0.001 and p = 0.001, respectively), size ≥ 50 mm (p = 0.021), lymph node (LN) metastases (p = 0.005), and R1 resections (p = 0.019). We stratified survival for each type of pattern according to the other prognostic factors identified in the multivariate analysis. N0 and R0 patients with type II and III tumors had encouraging long-term results. Conversely, patients with LN metastases and R1 resections had poor prognosis, particularly patients with type III tumors.CONCLUSION: ICC has distinct patterns of distribution with different prognoses that should be considered when making therapeutic decisions. Patients with type III tumors had a significantly worse prognosis, and the benefits of upfront surgery should be carefully evaluated.

U2 - 10.1245/s10434-018-6669-1

DO - 10.1245/s10434-018-6669-1

M3 - Article

C2 - 30088126

VL - 25

SP - 3719

EP - 3727

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 12

ER -