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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2024

06-11-2023 | Cholangiocarcinoma | Hepatobiliary Tumors

Classification of Intrahepatic Cholangiocarcinoma into Perihilar Versus Peripheral Subtype

Authors: Tao Wei, MD, Jianfeng Lu, MD, Xue-Lian Xiao, MD, Matthew Weiss, MD, Irinel Popescu, MD, Hugo P. Marques, MD, Luca Aldrighetti, MD, Shishir K. Maithel, MD, Carlo Pulitano, MD, Todd W. Bauer, MD, Feng Shen, MD, George A. Poultsides, MD, Oliver Soubrane, MD, Guillaume Martel, MD, Bas Groot Koerkamp, MD, Endo Itaru, MD, Yi Lv, MD, Xu-Feng Zhang, MD, PhD, Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, International Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma Study Groups, U.S. Extrahepatic Biliary Malignancy Consortium

Published in: Annals of Surgical Oncology | Issue 2/2024

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Abstract

Background

Intrahepatic cholangiocarcinoma (ICC) constitutes a group of heterogeneous malignancies within the liver. We sought to subtype ICC based on anatomical origin of tumors, as well as propose modifications of the current classification system.

Methods

Patients undergoing curative-intent resection for ICC, hilar cholangiocarcinoma (CCA), or hepatocellular carcinoma (HCC) were identified from three international multi-institutional consortia of databases. Clinicopathological characteristics and survival outcomes were assessed.

Results

Among 1264 patients with ICC, 1066 (84.3%) were classified as ICC-peripheral subtype, whereas 198 (15.7%) were categorized as ICC-perihilar subtype. Compared with ICC-peripheral subtype, ICC-perihilar subtype was more often associated with aggressive tumor characteristics, including a higher incidence of nodal metastasis, macro- and microvascular invasion, perineural invasion, as well as worse overall survival (OS) (median: ICC-perihilar 19.8 vs. ICC-peripheral 37.1 months; p < 0.001) and disease-free survival (DFS) (median: ICC-perihilar 12.8 vs. ICC-peripheral 15.2 months; p = 0.019). ICC-perihilar subtype and hilar CCA had comparable OS (19.8 vs. 21.4 months; p = 0.581) and DFS (12.8 vs. 16.8 months; p = 0.140). ICC-peripheral subtype tumors were associated with more advanced tumor features, as well as worse survival outcomes versus HCC (OS, median: ICC-peripheral 37.1 vs. HCC 74.3 months; p < 0.001; DFS, median: ICC-peripheral 15.2 vs. HCC 45.5 months; p < 0.001).

Conclusions

ICC should be classified as ICC-perihilar and ICC-peripheral subtype based on distinct clinicopathological features and survival outcomes. ICC-perihilar subtype behaved more like carcinoma of the bile duct (i.e., hilar CCA), whereas ICC-peripheral subtype had features and a prognosis more akin to a primary liver malignancy.
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Metadata
Title
Classification of Intrahepatic Cholangiocarcinoma into Perihilar Versus Peripheral Subtype
Authors
Tao Wei, MD
Jianfeng Lu, MD
Xue-Lian Xiao, MD
Matthew Weiss, MD
Irinel Popescu, MD
Hugo P. Marques, MD
Luca Aldrighetti, MD
Shishir K. Maithel, MD
Carlo Pulitano, MD
Todd W. Bauer, MD
Feng Shen, MD
George A. Poultsides, MD
Oliver Soubrane, MD
Guillaume Martel, MD
Bas Groot Koerkamp, MD
Endo Itaru, MD
Yi Lv, MD
Xu-Feng Zhang, MD, PhD
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA
International Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma Study Groups
U.S. Extrahepatic Biliary Malignancy Consortium
Publication date
06-11-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14502-3

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