The MEGNA Score and Preoperative Anemia are Major Prognostic Factors After Resection in the German Intrahepatic Cholangiocarcinoma Cohort

Purpose: To evaluate factors associated with survival following transarterial 90Y (yttrium) radioembolization (TARE) in patients with advanced intrahepatic cholangiocarcinoma (ICC). Methods: This retrospective multicenter study analyzed the outcome of three tertiary care cancer centers in patients with advanced ICC following resin microsphere TARE. Patients were included either after failed previous anticancer therapy, including relapse after surgical resection, or for having a minimum of 25% of total liver volume affected by ICC. Patients were stratified and response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) criteria at 3 months. Kaplan–Meier analysis was performed to analyze survival followed by cox regression to determine independent prognostic factors for survival. Results: 46 patients were included (19 male, 27 female), median age 62.5 years (range 29–88 years). A total of 65% of patients had undergone previous therapy, while 63% had a tumor volume > 25% of the entire liver volume. Median survival was 9.5 months (95% CI: 6.1–12.9 months). Due to loss in follow-up, n = 37 patients were included in the survival analysis. Cox regression revealed the extent of liver disease to one or both liver lobes being associated with survival, irrespective of tumor volume (p = 0.041). Patients with previous surgical resection of ICC had significantly decreased survival (3.9 vs. 12.8 months, p = 0.002). No case of radiation-induced liver disease was observed. Discussion: Survival after 90Y TARE in patients with advanced ICC primarily depends on disease extent. Only limited prognostic factors are associated with a general poor overall survival.

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Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-01962-4 ◽

2020 ◽

Vol 405 (7) ◽

pp. 977-988

Author(s):

Oliver Beetz ◽

Clara A. Weigle ◽

Sebastian Cammann ◽

Florian W. R. Vondran ◽

Kai Timrott ◽

...

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Postoperative Complications ◽

Intrahepatic Cholangiocarcinoma ◽

Postoperative Morbidity ◽

Severity Index ◽

The Body ◽

Morbidity And Mortality ◽

Independent Risk Factors ◽

Risk Factors For Survival

Abstract Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. Methods This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. Results Median postoperative follow-up time was 22.93 (0.10–234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. Conclusion Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.

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Retrospective Analysis of Prognostic Factors after Liver Transplantation for Intrahepatic Cholangiocarcinoma in China: A Single-Center Experience

Hepatogastroenterology ◽

10.5754/hge10704 ◽

2011 ◽

Vol 58 (109) ◽

pp. 1255-1259 ◽

Cited By ~ 10

Author(s):

Xiao-Xing Hu ◽

Lu-Nan Yan

Keyword(s):

Liver Transplantation ◽

Prognostic Factors ◽

Retrospective Analysis ◽

Intrahepatic Cholangiocarcinoma ◽

Single Center ◽

Single Center Experience

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Survival time and its prognostic factors in advanced unresected cholangiocarcinoma without chemoradiation

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15681 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15681-e15681

Author(s):

J. Park ◽

M. Kim ◽

J. Kim ◽

J. Lee

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Survival Time ◽

Intrahepatic Cholangiocarcinoma ◽

Hilar Cholangiocarcinoma ◽

Treatment Method ◽

Control Groups ◽

Future Studies ◽

Kaplan Meier ◽

Dismal Prognosis

e15681 Background: To evaluate survival time and its prognostic factors contributing to survival of advanced unresected cholangiocarcinoma. Methods: We reviewed the experience of 330 patients with histologically proven unresected advanced intrahepatic and hilar cholangiocarcinoma and evaluated their survival time and significant prognostic factors. They did not receive any surgery, chemotherapy and radiotherapy and they underwent only palliative nonsurgical biliary drainage if it was needed to relieve biliary obstructive symptom. Results: Survival time of overall cholangiocarcinoma (median±SD) was 3.9±7.8 months; 3±5.3 months for intrahepatic cholangiocarcinoma, 5.9±10.1 months for hilar cholangiocarcinoma. By Kaplan-Meier survival analysis, intrahepatic cholangiocarcinoma patients survived significantly shorter than hilar cholangiocarcinoma patients. By multivariate analysis for intrahepatic cholangiocarcinoma, distant metastasis was independently associated with shorter survival time. Multivariate analysis for hilar cholangiocarcinoma showed initial CEA > 30 ng/dl were independent predictors of shorter survival. Conclusions: Patients with unresectable cholangiocarcinoma who do not undergo surgery, chemotherapy and/or radiotherapy have a dismal prognosis. We hope that the outcome of our study would help clinicians better predict the prognosis of cholangiocarcinoma patients not receiving such aggressive treatments. These data would be used as the comparable data for control groups of future studies to assess the outcome of newly designed or developed treatment method. No significant financial relationships to disclose.

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Treatment strategy for intrahepatic cholangiocarcinoma: From optimal surgical management to adjuvant therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.392 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 392-392

Author(s):

Yuji Morine ◽

Mitsuo Shimada ◽

Satoru Imura ◽

Tetsuya Ikemoto ◽

Yu Saito ◽

...

Keyword(s):

Prognostic Factors ◽

Bile Duct ◽

Adjuvant Therapy ◽

Intrahepatic Cholangiocarcinoma ◽

Surgical Strategy ◽

Bile Duct Resection ◽

Extended Surgery ◽

Period 2 ◽

Significant Difference ◽

Limited Surgery

392 Background: Surgical strategy for intrahepatic cholangiocarcinoma (IHCC) including systemic lymph nodes (LN) dissection is still controversial. Also, as adjuvant chemotherapy, we adopted this GFP regimen (GEM, 5-FU, and Cisplatin). We demonstrate the adequate surgical strategy, the effect of adjuvant therapy and the tumor malignancy evaluation. Methods: Study 1: Surgical strategy) In period 1 (1994.4-2004.3, n = 20), extended surgery was basically performed. In period 2 (2004.4~, n = 34), extent of hepatectomy is conducted according to tumor conditions. Swelling LN exterpation for macroscopic curability and bile duct resection for positive surgical margin are performed. Study2: Adjuvant GFP therapy) Induction of 2 cycles of GFP for advanced IHCC with prognostic factors (LN metastasis, intrahepatic metastasis and R2 resection). Study 3: Malignancy evaluation) Significance of serum CA19-9 levels, the relationships its levels and expressions ( immunostaining ) of hypoxic inducible factor 1 (HIF-1) /Histone deacetylase 1 (HDAC1) were evaluated. Results: Study 1) In period 2, LN dissection and extrahepatic bile duct resection were significantly infrequent. Surgical outcome is rather good regardless of limited surgery in recent periods (Period 1 vs. Period 2: 5yrs survival 24.9% vs. 34.9%, p = 0.119). There was no significant difference in recurrent pattern. Study 2) There were 32 cases had some kind of prognostic factors, and of these 11 patients received adjuvant GFP. Patient’s prognosis received adjuvant GFP was significantly prolonged (GFP vs. non GFP: 1yrs survival 71.6% vs. 45.0%, p < 0.02). Study 3) CA19-9 ( > 300U/ml) high group revealed the independent prognostic factor with stepwise model, as well as LN metastasis and vessels invasion. CA19-9 levels significantly correlated to HDAC1 and HIF-1 expressions. Conclusions: Extended surgery including LN dissection might not control malignant behavior of IHCC, and adjuvant GFP should be introduced in patients with poor prognostic factors.

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