Predicting risk of recurrence after resection of stage I intrahepatic cholangiocarcinoma

Jun Kawashima; Kota Sahara; Feng Shen; Alfredo Guglielmi; Luca Aldrighetti; Matthew Weiss; Todd W Bauer; Sorin Alexandrescu; George A Poultsides; Shishir K Maithel; Hugo P Marques; Guillaume Martel; Carlo Pulitano; François Cauchy; B Groot Koerkamp; Ryusei Matsuyama; Itaru Endo; Timothy M Pawlik

doi:10.1016/j.gassur.2023.10.002

Predicting risk of recurrence after resection of stage I intrahepatic cholangiocarcinoma

J Gastrointest Surg. 2024 Jan;28(1):18-25. doi: 10.1016/j.gassur.2023.10.002.

Authors

Jun Kawashima¹, Kota Sahara², Feng Shen³, Alfredo Guglielmi⁴, Luca Aldrighetti⁵, Matthew Weiss⁶, Todd W Bauer⁷, Sorin Alexandrescu⁸, George A Poultsides⁹, Shishir K Maithel¹⁰, Hugo P Marques¹¹, Guillaume Martel¹², Carlo Pulitano¹³, François Cauchy¹⁴, B Groot Koerkamp¹⁵, Ryusei Matsuyama¹, Itaru Endo¹, Timothy M Pawlik¹⁶

Affiliations

¹ Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
² Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan; Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, OH, United States.
³ Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
⁴ Department of Surgery, University of Verona, Verona, Italy.
⁵ Department of Surgery, Ospedale San Raffaele, Milano, Italy.
⁶ Department of Surgery, Northwell Health, Manhasset, NY, United States.
⁷ Department of Surgery, University of Virginia, Charlottesville, VA, United States.
⁸ Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
⁹ Department of Surgery, Stanford University, Stanford, CA, United States.
¹⁰ Department of Surgery, Emory University, Atlanta, GA, United States.
¹¹ Department of Surgery, Hospital Curry Cabral, Lisbon, Portugal.
¹² Department of Surgery, University of Ottawa, Ottawa, Canada.
¹³ Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
¹⁴ Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Public Assistance Hospitals of Paris, Beaujon Hospital, Clichy, France.
¹⁵ Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
¹⁶ Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, OH, United States. Electronic address: Tim.Pawlik@osumc.edu.

PMID: 38353070
DOI: 10.1016/j.gassur.2023.10.002

Abstract

Background: Early-stage intrahepatic cholangiocarcinoma (ICC) is often an indication of curative-intent resection. Although patients with early-stage ICC generally have a better prognosis than individuals with advanced ICC, the incidence and risk factors of recurrence after early-stage ICC remain unclear.

Methods: A multi-institutional database was used to identify patients who underwent surgery between 2000 and 2018 for ICC with pathologically confirmed stage I disease. Cox regression analysis was used to identify clinicopathological factors associated with recurrence, and an online prediction model was developed and validated.

Results: Of 430 patients diagnosed with stage I ICC, approximately one-half of patients (n = 221, 51.4%) experienced recurrence after curative-intent resection. Among patients with a recurrence, most (n = 188, 85.1%) experienced it within 12 months. On multivariable analysis, carcinoembryonic antigen (hazard ratio [HR], 1.011; 95% CI, 1.004-1.018), systemic immune-inflammation index (HR, 1.036; 95% CI, 1.019-1.056), no lymph nodes evaluated (HR, 1.851; 95% CI, 1.276-2.683), and tumor size (HR, 1.101; 95% CI, 1.053-1.151) were associated with greater hazards of recurrence. A predictive model that included these weighted risk factors demonstrated excellent prognostic discrimination in the test (12-month recurrence-free survival [RFS]: low risk, 80.1%; intermediate risk, 60.3%; high risk, 37.7%; P = .001) and validation (12-month RFS: low risk, 84.5%; intermediate risk, 63.5%; high risk, 47.1%; P = .036) datasets. The online predictive model was made available at https://ktsahara.shinyapps.io/stageI_icc/.

Conclusions: Patients with stage I ICC without vascular invasion or lymph node metastasis had a relatively high incidence of recurrence. An online tool can risk stratify patients relative to recurrence risk to identify individuals best suited for alternative treatment approaches.

Keywords: Adjuvant therapy; Early stage; Intrahepatic cholangiocarcinoma; Recurrence.

MeSH terms

Bile Duct Neoplasms* / pathology
Bile Ducts, Intrahepatic / surgery
Cholangiocarcinoma*
Hepatectomy / adverse effects
Humans
Neoplasm Recurrence, Local / pathology
Prognosis
Retrospective Studies