Specific risk factors contributing to early and late recurrences of intrahepatic cholangiocarcinoma after curative resection

doi:10.1186/s12957-018-1540-1

. 2019 Jan 3;17(1):2.

doi: 10.1186/s12957-018-1540-1.

Specific risk factors contributing to early and late recurrences of intrahepatic cholangiocarcinoma after curative resection

Changzheng Wang¹, Shujie Pang¹, Hui Si-Ma¹, Ning Yang¹, Haibin Zhang¹, Yong Fu², Guangshun Yang³

Affiliations

¹ Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225,Changhai Road, Shanghai, 200433, China.
² Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225,Changhai Road, Shanghai, 200433, China. xjtumedfuyg@sina.com.cn.
³ Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225,Changhai Road, Shanghai, 200433, China. yangguangshunlab@sina.com.

PMID: 30606203
PMCID: PMC6317206
DOI: 10.1186/s12957-018-1540-1

Specific risk factors contributing to early and late recurrences of intrahepatic cholangiocarcinoma after curative resection

Changzheng Wang et al. World J Surg Oncol. 2019.

. 2019 Jan 3;17(1):2.

doi: 10.1186/s12957-018-1540-1.

Authors

Changzheng Wang¹, Shujie Pang¹, Hui Si-Ma¹, Ning Yang¹, Haibin Zhang¹, Yong Fu², Guangshun Yang³

Affiliations

¹ Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225,Changhai Road, Shanghai, 200433, China.
² Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225,Changhai Road, Shanghai, 200433, China. xjtumedfuyg@sina.com.cn.
³ Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225,Changhai Road, Shanghai, 200433, China. yangguangshunlab@sina.com.

PMID: 30606203
PMCID: PMC6317206
DOI: 10.1186/s12957-018-1540-1

Abstract

Background: Most intrahepatic cholangiocarcinoma (ICC) patients experienced tumor recurrences even after curative resection, but the optimal cut-off time point and the specific risk factors for early and late recurrences of ICC have not been clearly defined. The objective of the current study was to define specific risk factors for early and late recurrences of ICC after radical hepatectomy.

Methods: Included in this study were 259 ICC patients who underwent curative surgery at our hospital between January 2005 and December 2009. Recurrences in these patients were followed-up prospectively. Piecewise regression model and the minimum P value approach were used to estimate the optimal cut-off time point for early and late recurrences. Then, Cox's proportional hazards regression model was used to identify specific independent risk factors for early and late recurrences.

Results: Early and late recurrences occurred in 130 and 74 patients, respectively, and the 12th month was confirmed as the optimal cut-off time point for early and late recurrences. Cox's proportional hazards regression model showed that microvascular invasion (HR = 2.084, 95% CI 1.115-3.897, P = 0.021), multiple tumors (HR = 2.071, 95% CI 1.185-3.616, P = 0.010), abnormal elevation of serum CA19-9 (HR = 1.619, 95% CI 1.076-2.437, P = 0.021), and the negative hepatitis B status (HR = 1.650, 95% CI 1.123-2.427, P = 0.011) were independent risk factors for early recurrence, and HBV-DNA level > 10⁶ IU/mL (HR = 1.785, 95% CI 1.015-3.141, P = 0.044) and a hepatolithiasis history (HR = 2.538, 95% CI 1.165-5.533, P = 0.010) contributed to late recurrence independently.

Conclusion: Specific risk factors and mechanisms may relate to early and late recurrences of ICC after curative resection.

Keywords: Cholangiocarcinoma; Hepatectomy; Prognosis; Recurrence; Risk factor.

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Conflict of interest statement

Ethics approval and consent to participate

This study complied with the ethical guidelines of the Declaration of Helsinki and was approved by the ethics committee of the Eastern Hepatobiliary Surgery Hospital.

Consent for publication

Consent for publication was obtained from each patient included in this study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Cumulative recurrence-free survival curve of 259 ICC patients after curative hepatectomy

**Fig. 2**
The optimal cut-off time point estimated by piecewise regression model

**Fig. 3**
The optimal cut-off time point verified in the minimum P value approach

**Fig. 4**
OS of ICC patients with early or late recurrence (p < 0.001)

See this image and copyright information in PMC

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References

1. Massarweh NN, El-Serag HB. Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Cancer Control. 2017;24(3):11. doi: 10.1177/1073274817729245. - DOI - PMC - PubMed
1. Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60:1268–1289. doi: 10.1016/j.jhep.2014.01.021. - DOI - PubMed
1. Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet. 2014;383(9935):2168–2179. doi: 10.1016/S0140-6736(13)61903-0. - DOI - PMC - PubMed
1. Wang K, Zhang H, Xia Y, et al. Surgical options for intrahepatic cholangiocarcinoma. Hepatobil Surg Nutr. 2017;6(2):79–90. doi: 10.21037/hbsn.2017.01.06. - DOI - PMC - PubMed
1. Sasaki K, Margonis GA, Andreatos N, et al. Preoperative risk score and prediction of long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma. J Am Coll Surgeons. 2018;226(4):393–405. doi: 10.1016/j.jamcollsurg.2017.12.011. - DOI - PubMed

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[1] Massarweh NN, El-Serag HB. Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Cancer Control. 2017;24(3):11. doi: 10.1177/1073274817729245. - DOI - PMC - PubMed

[2] Massarweh NN, El-Serag HB. Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Cancer Control. 2017;24(3):11. doi: 10.1177/1073274817729245. - DOI - PMC - PubMed

[3] Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60:1268–1289. doi: 10.1016/j.jhep.2014.01.021. - DOI - PubMed

[4] Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60:1268–1289. doi: 10.1016/j.jhep.2014.01.021. - DOI - PubMed

[5] Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet. 2014;383(9935):2168–2179. doi: 10.1016/S0140-6736(13)61903-0. - DOI - PMC - PubMed

[6] Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet. 2014;383(9935):2168–2179. doi: 10.1016/S0140-6736(13)61903-0. - DOI - PMC - PubMed

[7] Wang K, Zhang H, Xia Y, et al. Surgical options for intrahepatic cholangiocarcinoma. Hepatobil Surg Nutr. 2017;6(2):79–90. doi: 10.21037/hbsn.2017.01.06. - DOI - PMC - PubMed

[8] Wang K, Zhang H, Xia Y, et al. Surgical options for intrahepatic cholangiocarcinoma. Hepatobil Surg Nutr. 2017;6(2):79–90. doi: 10.21037/hbsn.2017.01.06. - DOI - PMC - PubMed

[9] Sasaki K, Margonis GA, Andreatos N, et al. Preoperative risk score and prediction of long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma. J Am Coll Surgeons. 2018;226(4):393–405. doi: 10.1016/j.jamcollsurg.2017.12.011. - DOI - PubMed

[10] Sasaki K, Margonis GA, Andreatos N, et al. Preoperative risk score and prediction of long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma. J Am Coll Surgeons. 2018;226(4):393–405. doi: 10.1016/j.jamcollsurg.2017.12.011. - DOI - PubMed

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