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Multicenter Study
. 2019 Nov;23(11):2239-2246.
doi: 10.1007/s11605-019-04184-2. Epub 2019 Mar 18.

Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma

Stefan Buettner  1 , David W G Ten Cate  1 , Fabio Bagante  2 , Sorin Alexandrescu  3 , Hugo P Marques  4 , Jorge Lamelas  4 , Luca Aldrighetti  5 , T Clark Gamblin  6 , Shishir K Maithel  7 , Carlo Pulitano  8 , Georgios Antonios Margonis  9 , Matthew Weiss  9 , Todd W Bauer  10 , Feng Shen  11 , George A Poultsides  12 , J Wallis Marsh  13 , Jan N M IJzermans  1 , Timothy M Pawlik  2 , Bas Groot Koerkamp  14
Affiliations
Multicenter Study

Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma

Stefan Buettner et al. J Gastrointest Surg. 2019 Nov.

Abstract

Background: Multiple tumor foci of intrahepatic cholangiocarcinoma (ICC) are often considered a contra-indication for resection. We sought to define long-term outcomes after resection of ICC in patients with multiple foci.

Methods: Patients who underwent resection for ICC between 1990 and 2017 were identified from 12 major HPB centers. Outcomes of patients with solitary lesions, multiple lesions (ML), and oligometastases (OM) were compared. OM were defined as extrahepatic metastases spread to a single organ.

Results: One thousand thirteen patients underwent resection of ICC. On final pathology, 185 patients (18.4%) had ML and 27 (2.7%) had OM. Median survival of patients with a solitary tumor was 43.2 months, while the median survival of patients with 2 tumors was 21.2 months; the median survival of patients with 3 or more tumors was 15.3 months (p < 0.001). Five-year survival was 43.3%, 28.0%, and 8.6%, respectively. The median survival of patients without OM was 37.8 months versus 14.9 months among patients with OM (p < 0.001); estimated 5-year survival was 39.3% and 10.6%, respectively. In multivariable analysis, the presence of two lesions was not an independent poor prognostic factor for OS (HR 1.19; 95%CI 0.90-1.57; p = 0.229). However, the presence of three or more tumors was an independent poor prognostic factor for OS (HR 1.97; 95%CI 1.48-2.64; p < 0.001).

Conclusion: Resection of multiple liver tumors for patients with ICC did not preclude 5-year survival: in particular, estimated 5-year OS for resection of two tumors was 28.0%.

Keywords: Intrahepatic cholangiocarcinoma; Multiple tumor location; Prognostic staging; Survival.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Overall survival stratified by presence of intrahepatic metastases (p < 0.001)
Fig. 2
Fig. 2
Overall survival stratified by presence of oligometastases (p < 0.001)
See this image and copyright information in PMC

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