Author(s):
Hyder, O 
; Hatzaras, I ; Sotiropoulos, G ; Paul, A ; Alexandrescu, S ; Marques, H ; Pulitano, C ; Barroso, E ; Clary, B ; Aldrighetti, L ; Ferrone, C ; Zhu, A ; Bauer, T ; Walters, D ; Groeschl, R ; Gamblin, C ; Marsh, J ; Nguyen, K ; Turley, R ; Popescu, I ; Hubert, C ; Meyer, S ; Choti, M ; Gigot, JF ; Mentha, G ; Pawlik, T
Date: 2013
Persistent ID: http://hdl.handle.net/10400.17/1291
Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
Subject(s): Colangiocarcinoma; Neoplasias das Vias Biliares; Vias Biliares Intra-Hepáticas; Sobrevivência Livre de Doença; Estimativa de Kaplan-Meier; Neoplasias Hepáticas; Metástases Linfáticas; Invasão Neoplásica; Factores de Risco; Recidiva Neoplásica Local
Description
INTRODUCTION: Data on recurrence after operation for intrahepatic cholangiocarcinoma (ICC) are limited. We sought to investigate rates and patterns of recurrence in patients after operative intervention for ICC.
METHODS: We identified 301 patients who underwent operation for ICC between 1990 and 2011 from an international, multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed.
RESULTS: During the median follow up duration of 31 months (range 1-208), 53.5% developed a recurrence. Median RFS was 20.2 months and 5-year actuarial disease-free survival, 32.1%. The most common site for initial recurrence after operation of ICC was intrahepatic (n = 98; 60.9%), followed by simultaneous intra- and extrahepatic disease (n = 30; 18.6%); 33 (21.0%) patients developed extrahepatic recurrence only as the first site of recurrence. Macrovascular invasion (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.34-3.21; P < .001), nodal metastasis (HR, 1.55; 95% CI, 1.01-2.45; P = .04), unknown nodal status (HR, 1.57; 95% CI, 1.10-2.25; P = .04), and tumor size ≥5 cm (HR, 1.84; 95% CI, 1.28-2.65; P < .001) were independently associated with increased risk of recurrence. Patients were assigned a clinical score from 0 to 3 according to the presence of these risk factors. The 5-year RFS for patients with scores of 0, 1, 2, and 3 was 61.8%, 36.2%, 19.5%, and 9.6%, respectively.
CONCLUSION: Recurrence after operative intervention for ICC was common. Disease recurred both at intra- and extrahepatic sites with roughly the same frequency. Factors such as lymph node metastasis, tumor size, and vascular invasion predict highest risk of recurrence.
