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. 2020 Dec;9(6):744-755.
doi: 10.1159/000509059. Epub 2020 Oct 28.

Surveillance for Hepatocellular Carcinoma Also Improves Survival of Incidentally Detected Intrahepatic Cholangiocarcinoma Arisen in Liver Cirrhosis

Francesco Tovoli  1 , Pietro Guerra  1 , Massimo Iavarone  2 , Letizia Veronese  3 , Matteo Renzulli  4 , Stefania De Lorenzo  5 , Francesca Benevento  1 , Giovanni Brandi  5 , Federico Stefanini  1 , Fabio Piscaglia  1
Affiliations

Surveillance for Hepatocellular Carcinoma Also Improves Survival of Incidentally Detected Intrahepatic Cholangiocarcinoma Arisen in Liver Cirrhosis

Francesco Tovoli et al. Liver Cancer. 2020 Dec.

Abstract

Background: Due to its poor survival, intrahepatic cholangiocarcinoma (ICC) is held to be a much more aggressive cancer than hepatocellular carcinoma (HCC). In most published series, patients were diagnosed when symptomatic. However, ICC is now increasingly being discovered during the surveillance for HCC in cirrhosis. Whether this earlier detection of ICC is associated with an equally dismal prognosis or not is unknown.

Methods: This is amulticenter retrospective study of consecutive ICC patients. Patients were stratified into subgroups according to the absence/presence of cirrhosis. A propensity score matching was performed to reduce the potential biases. Cirrhotic patients were further stratified according to their surveillance status. The lead-time bias and its potential effects were also estimated.

Results: We gathered 184 patients. Eighty-five patients (46.2%) were cirrhotic. Liver cirrhosis was not related to a worse overall survival (33.0 vs. 32.0 months, p = 0.800) even after the propensity score analysis (43.0 in vs. 44.0 months in 54 pairs of patients, p = 0.878). Among the cirrhotic population, 47 (55.3%) patients had received a diagnosis of ICC during a surveillance programme. The 2 subgroups differed in maximum tumour dimensions (30 vs. 48 mm in surveyed and non-surveyed patients, respectively). Surveyed patients were more likely to receive surgical treatments (59.8 vs. 28.9%, p = 0.003). Overall survival was higher in surveyed patients (51.0 vs. 21.0 months, p < 0.001). These benefits were confirmed after correcting for the lead-time bias.

Conclusions: Cirrhotic patients have different clinical presentation and outcomes of ICC according to their surveillance status. In our series, ICC in cirrhosis was not associated with worse OS. Cirrhosis itself should not discourage either surgical or non-surgical treatments.

Keywords: Cholangiocellular carcinoma; Intrahepatic cholangiocarcinoma; Liver cirrhosis; Outcomes; Screening.

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Conflict of interest statement

Francesco Tovoli: consultant for Bayer AG and advisory board for LaForce; Pietro Guerra: no conflicts to declare; Massimo Iavarone: speaker honoraria from Bayer, Gilead Science, Janssen, BTG, Abbvie, and MSD and consultant for BTG; Letizia Veronese: no conflicts to declare; Matteo Renzulli: no conflicts to declare; Stefania De Lorenzo: no conflicts to declare; Francesca Benevento: no conflicts to declare; Giovanni Brandi: advisory board for Eli-Lilly; Federico Stefanini: no conflicts to declare; Fabio Piscaglia: consultant for Astrazeneca, Bayer AG, EISAI, GE, and Tiziana life sciences; speaker's bureau honoraria from Bayer AG, Bracco, EISAI, and Laforce; and research contract with Esaote.

Figures

Fig. 1
Fig. 1
OS stratified according to the TNM stage in the whole study population. OS, overall survival.
Fig. 2
Fig. 2
OS stratified according to the treatment received in the whole study population. OS, overall survival.
Fig. 3
Fig. 3
Comparison of OS between non-cirrhotic versus cirrhotic patients as a whole (a) and non-cirrhotic versus cirrhotic patients stratified according to their surveillance status (b). OS, overall survival.
Fig. 4
Fig. 4
Comparison of OS between surveyed and non-surveyed cirrhotic patients following the adjustment for the lead-time bias. OS, overall survival.
See this image and copyright information in PMC

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