Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2019

01-08-2019 | Cholangiocarcinoma | Hepatobiliary Tumors

Recurrence Patterns and Timing Courses Following Curative-Intent Resection for Intrahepatic Cholangiocarcinoma

Authors: Liang-Shuo Hu, MD, PhD, Xu-Feng Zhang, MD, PhD, 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, B. Groot Koerkamp, MD, Endo Itaru, MD, Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon)

Published in: Annals of Surgical Oncology | Issue 8/2019

Login to get access

Abstract

Background

Recurrence of intrahepatic cholangiocarcinoma (ICC) after curative resection is common.

Objective

The aim of this study was to investigate the patterns, timing and risk factors of disease recurrence after curative-intent resection for ICC.

Methods

Patients undergoing curative resection for ICC were identified from a multi-institutional database. Data on clinicopathological and initial operation information, timing and first sites of recurrence, recurrence management, and long-term outcomes were analyzed.

Results

A total of 920 patients were included. With a median follow-up of 38 months, 607 patients (66.0%) experienced ICC recurrence. In the cohort, 145 patients (23.9%) recurred at the surgical margin, 178 (29.3%) recurred within the liver away from the surgical margin, 90 (14.8%) recurred at extraheptatic sites, and 194 (32.0%) developed both intrahepatic and extrahepatic recurrence. Intrahepatic margin recurrence (median 6.0 m) and extrahepatic-only recurrence (median 8.0 m) tended to occur early, while intrahepatic recurrence at non-margin sites occurred later (median 14.0 m; p < 0.05). On multivariate analysis, surgical margin < 10 mm was associated with increased margin recurrence (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.11–2.60; p = 0.014), whereas female sex (HR 2.12, 95% CI 1.40–3.22; p < 0.001) and liver cirrhosis (HR 2.36, 95% CI 1.31–4.25; p = 0.004) were both associated with an increased risk of intrahepatic recurrence at other sites. Median survival after recurrence was better among patients who underwent repeat curative-intent surgery (48.7 months) versus other treatments (9.7 months) [p < 0.001].

Conclusions

Different recurrence patterns and timing of recurrence suggest biological heterogeneity of ICC tumor recurrence. Understanding timing and risk factors associated with different types of recurrence can hopefully inform discussions around adjuvant therapy, surveillance, and treatment of recurrent disease.
Appendix
Available only for authorised users
Literature
1.
Amini N, Ejaz A, Spolverato G, Kim Y, Herman JM, Pawlik TM. Temporal trends in liver-directed therapy of patients with intrahepatic cholangiocarcinoma in the United States: a population-based analysis. J Surg Oncol. 2014;110:163–70.CrossRefPubMed
2.
3.
Doussot A, Gonen M, Wiggers JK, et al. Recurrence patterns and disease-free survival after resection of intrahepatic cholangiocarcinoma: preoperative and postoperative prognostic models. J Am Coll Surg. 2016;223:493–505 e2.
4.
Spolverato G, Kim Y, Alexandrescu S, et al. Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative-intent surgical resection. Ann Surg Oncol. 2016;23:235–43.CrossRefPubMed
5.
Sulpice L, Rayar M, Boucher E, Pracht M, Meunier B, Boudjema K. Treatment of recurrent intrahepatic cholangiocarcinoma. Br J Surg. 2012;99:1711–7.CrossRefPubMed
6.
Wang Y, Li J, Xia Y, et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol. 2013;31:1188–95.CrossRefPubMed
7.
Spolverato G, Vitale A, Cucchetti A, et al. Can hepatic resection provide a long-term cure for patients with intrahepatic cholangiocarcinoma? Cancer. 2015;121:3998–4006.CrossRefPubMed
8.
Ercolani G, Vetrone G, Grazi GL, et al. Intrahepatic cholangiocarcinoma: primary liver resection and aggressive multimodal treatment of recurrence significantly prolong survival. Ann Surg. 2010;252:107–14.CrossRefPubMed
9.
Tabrizian P, Jibara G, Shrager B, Schwartz M, Roayaie S. Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg. 2015;261:947–55.CrossRefPubMed
10.
Hirokawa F, Hayashi M, Asakuma M, Shimizu T, Inoue Y, Uchiyama K. Risk factors and patterns of early recurrence after curative hepatectomy for hepatocellular carcinoma. Surg Oncol. 2016;25:24–9.CrossRefPubMed
11.
Zhang XF, Beal EW, Bagante F, et al. Early versus late recurrence of intrahepatic cholangiocarcinoma after resection with curative intent. Br J Surg. 2018;105:848–56.CrossRefPubMed
12.
Poon RT, Fan ST, Ng IO, Lo CM, Liu CL, Wong J. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer. 2000;89:500–7.CrossRefPubMed
13.
Imamura H, Matsuyama Y, Tanaka E, et al. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 2003;38:200–7.CrossRefPubMed
14.
Portolani N, Coniglio A, Ghidoni S, et al. Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg. 2006;243:229–35.CrossRefPubMedPubMedCentral
15.
Cucchetti A, Piscaglia F, Caturelli E, et al. Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population. Ann Surg Oncol. 2009;16:413–22.CrossRefPubMed
16.
Zhang XF, Beal EW, Chakedis J, et al. Early Recurrence of neuroendocrine liver metastasis after curative hepatectomy: risk factors, prognosis, and treatment. J Gastrointest Surg. 2017;21(11):1821–30.CrossRefPubMed
17.
Amin MB. American Joint Committee on Cancer. AJCC cancer staging manual. Chicago: Springer; 2017.CrossRef
18.
Okusaka T, Okada S, Ueno H, et al. Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features. Cancer. 2002;95:1931–7.CrossRefPubMed
19.
Li MX, Bi XY, Li ZY, et al. Impaction of surgical margin status on the survival outcome after surgical resection of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis. J Surg Res. 2016;203:163–73.CrossRefPubMed
20.
Mavros MN, Economopoulos KP, Alexiou VG, Pawlik TM. Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis. JAMA Surg. 2014;149:565–74.CrossRefPubMed
21.
Zhang XF, Bagante F, Chakedis J, et al. Perioperative and long-term outcome for intrahepatic cholangiocarcinoma: impact of major versus minor hepatectomy. J Gastrointest Surg. 2017;21:1841–50.CrossRefPubMed
22.
Spolverato G, Yakoob MY, Kim Y, et al. The impact of surgical margin status on long-term outcome after resection for intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2015;22:4020–8.CrossRefPubMed
23.
Hyder O, Marques H, Pulitano C, et al. A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience. JAMA Surg. 2014;149:432–8.CrossRefPubMed
24.
Tarchi P, Tabrizian P, Prigoff J, Schwartz M. Outcomes of resection for solitary ≤ 5 cm intrahepatic cholangiocarcinoma. Surgery. 2018;163:698–702.CrossRefPubMed
25.
Zhang XF, Chakedis J, Bagante F, et al. Implications of intrahepatic cholangiocarcinoma etiology on recurrence and prognosis after curative-intent resection: a multi-institutional study. World J Surg. 2018;42:849–57.CrossRefPubMed
26.
Buettner S, Galjart B, van Vugt JLA, et al. Performance of prognostic scores and staging systems in predicting long-term survival outcomes after surgery for intrahepatic cholangiocarcinoma. J Surg Oncol. 2017;116:1085–95.CrossRefPubMed
27.
Kim Y, Moris DP, Zhang XF, et al. Evaluation of the 8th edition American Joint Commission on Cancer (AJCC) staging system for patients with intrahepatic cholangiocarcinoma: A surveillance, epidemiology, and end results (SEER) analysis. J Surg Oncol. 2017;116(6):643–50.
28.
Spolverato G, Ejaz A, Kim Y, et al. Tumor size predicts vascular invasion and histologic grade among patients undergoing resection of intrahepatic cholangiocarcinoma. J Gastrointest Surg. 2014;18:1284–91.CrossRefPubMed
29.
Si A, Li J, Xing X, et al. Effectiveness of repeat hepatic resection for patients with recurrent intrahepatic cholangiocarcinoma: factors associated with long-term outcomes. Surgery. 2017;161:897–908.CrossRefPubMed
30.
31.
Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362:1273–81.CrossRefPubMed
32.
Mizusawa J, Morizane C, Okusaka T, et al. Randomized phase III study of gemcitabine plus S-1 versus gemcitabine plus cisplatin in advanced biliary tract cancer: Japan Clinical Oncology Group Study (JCOG1113, FUGA-BT). Jpn J Clin Oncol. 2016;46:385–8.CrossRefPubMedPubMedCentral
Metadata
Title
Recurrence Patterns and Timing Courses Following Curative-Intent Resection for Intrahepatic Cholangiocarcinoma
Authors
Liang-Shuo Hu, MD, PhD
Xu-Feng Zhang, MD, PhD
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
B. Groot Koerkamp, MD
Endo Itaru, MD
Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon)
Publication date
01-08-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07353-4

Other articles of this Issue 8/2019

Annals of Surgical Oncology 8/2019 Go to the issue

Health Services Research and Global Oncology

Palliative Care and Symptom Burden in the Last Year of Life: A Population-Based Study of Patients with Gastrointestinal Cancer

Peritoneal Surface Malignancy

Discordant Diagnostic Terminology and Pathologic Grading of Primary Appendiceal Mucinous Neoplasms Reviewed at a High-Volume Center

COLORECTAL CANCER

Laparoscopic Complete Mesocolic Excision for Double Flexural Colon Cancers

Hepatobiliary Tumors

Full Laparoscopic Anatomical Segment 8 Resection for Hepatocellular Carcinoma Using the Glissonian Approach with Indocyanine Green Dye Fluorescence

Thoracic Oncology

Predicting the Value of Adjuvant Therapy in Esophageal Squamous Cell Carcinoma by Combining the Total Number of Examined Lymph Nodes with the Positive Lymph Node Ratio

Gynecologic Oncology

Para-aortic Lymphadenectomy for Gynecologic Cancers: Introducing the “Trans-Retro-Peritoneal (TRP) Single-Port Access”