Intrahepatic Cholangiocarcinoma: An International Multi-Institutional Analysis of Prognostic Factors and Lymph Node Assessment

Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 08/2011; 29(23):3140-5. DOI: 10.1200/JCO.2011.35.6519
Source: PubMed


To identify factors associated with outcome after surgical management of intrahepatic cholangiocarcinoma (ICC) and examine the impact of lymph node (LN) assessment on survival.
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.
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).
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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Available from: Carlo Pulitano, Sep 30, 2015
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    • "However, extrapolating from colorectal data, [163] the prognosis of patients with ''gross'' hilar adenopathy is particularly poor with few long-term survivors . In addition to lymph node disease, the presence of either intrahepatic metastasis or major vascular invasion similarly have a 5-year survival in the range of 20% or less with the vast majority of patients experiencing a recurrence [149] [164]. Given the very poor prognosis of patients who have clinically evident lymph node metastasis, intrahepatic metastasis or major vascular invasion , these factors should be considered relatively strong contraindications to surgical resection. "
    Journal of Hepatology 06/2014; 60(6). DOI:10.1016/j.jhep.2014.01.021 · 11.34 Impact Factor
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    • "Conduct of clinical trials using these agents can be considered for determination of the efficacy of adjuvant therapy in BDC. As other authors have previously mentioned [16,17], lymph node involvement, lymphatic invasion, and venous invasion were related to poor prognosis in ICC, but not in the other two types of BDC. However, the degree of differentiation was associated with prognosis in HC and EHC, but not in ICC. "
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    ABSTRACT: There are three types of bile duct cancer, intrahepatic cholangiocarcinoma (ICC), hilar cholangiocarcinoma (HC), and extrahepatic cholangiocarcinoma (EHC). Despite different clinical presentation, the same protocol has been used in treatment of patients with these cancers. We analyzed clinicopathologic findings and protein expression in order to investigate the difference and the specific prognostic factors among these three types of cancers. We conducted a retrospective review of 104 patients diagnosed with bile duct cancer at Seoul St. Mary's Hospital between January 1994 and May 2004. We performed immunohistochemical staining for p53, cyclin D1, thymidine phosphorylase, survivin, and excision repair cross-complementing group 1 (ERCC1). Of the 104 patients, EHC was most common (44.2%). In pathologic findings, perineural invasion was significantly less common in ICC. Overall survival was similar among the three types of cancer. Lymph node invasion, lymphatic, and venous invasion showed a significant association with survival outcome in ICC, however, the differentiation of histologic grade had prognostic significance in HC and EHC. No difference in protein expression was observed among these types of cancer, however, ERCC1 showed a significant association with survival outcome in HC and EHC, not in ICC. Based on our data, ICC showed different characteristics and prognostic factors, separate from the other two types of bile duct cancer. Conduct of further studies with a large sample size is required in order to confirm these data.
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