Recurrence Patterns and Disease-Free Survival after Resection of Intrahepatic Cholangiocarcinoma: Preoperative and Postoperative Prognostic Models

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• 作者：Alexandre Doussot ; MD^a ; ^f ; Mithat Gonen ; PhD^b ; Jimme K. Wiggers ; MD ; PhD^a ; Bas Groot-Koerkamp ; MD ; PhD^a ; Ronald P. DeMatteo ; MD ; FACS^a ; David Fuks ; MD ; PhD^c ; Peter J. Allen ; MD ; FACS^a ; Olivier Farges ; MD ; PhD^d ; T. Peter Kingham ; MD ; FACS^a ; Jean Marc Regimbeau ; MD ; PhD^e ; Michael I. D'Angelica ; MD ; FACS^a ; Daniel Azoulay ; MD ; PhD^f ; William R. Jarnagin ; MD ; FACS^a ; ^{jarnagiw@mskcc.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：DFS ; disease-free survival ; HAI-FUDR ; hepatic arterial infusion with floxuridine ; HR ; hazard ratio ; IHCC ; intrahepatic cholangiocarcinoma ; OS ; overall survival
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：223
• 期：3
• 页码：493-505.e2
• 全文大小：1704 K

文摘

Liver resection is the most effective treatment for intrahepatic cholangiocarcinoma. Recurrent disease is frequent; however, recurrence patterns are ill-defined and prognostic models are lacking.

Study Design

A primary cohort of 189 patients who underwent resection for intrahepatic cholangiocarcinoma was used for recurrence patterns analysis within and after 24 months. Based on independent factors for disease-free survival identified in Cox regression analysis, preoperative and postoperative models were developed using a recursive partitioning method. Models were externally validated using a multicenter cohort of 522 resected patients (Association Française de Chirurgie intrahepatic cholangiocarcinoma study group).

Results

Recurrence within 24 months most often involved the liver (82.7%), and most recurrences after 24 months were strictly extrahepatic (61.1%). In multivariable analysis of the primary cohort, independent preoperative factors for disease-free survival were tumor size and multifocality (based on imaging); tumor size, multifocality, vascular invasion, and lymph node metastases (based on pathology) were independent postoperative factors. The preoperative model allowed patient classification into low-risk and high-risk groups for recurrence. In the validation cohort (n = 522), high-risk patients had a greater likelihood of recurrence (hazard ratio = 2.17; 95% CI, 1.74–2.72; p < 0.001). The postoperative model included tumor size, vascular invasion, and positive nodal disease on pathology and classified patients in low-, intermediate-, and high-risk groups in the primary cohort. As compared with low-risk patients in the validation cohort, intermediate- and high-risk patients were more likely to experience recurrence (hazard ratio = 1.9; 95% CI, 1.41–2.47; p < 0.001 and hazard ratio = 2.99; 95% CI, 2.08–4.31; p < 0.001, respectively).

Conclusions

Recurrence patterns are time dependent. Both models as developed and validated in this study classified patients in distinct recurrence risk groups, which can guide treatment recommendations.