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. 2022 Mar 7:12:829407.
doi: 10.3389/fonc.2022.829407. eCollection 2022.

Tumor Burden Score Stratifies Prognosis of Patients With Intrahepatic Cholangiocarcinoma After Hepatic Resection: A Retrospective, Multi-Institutional Study

Hui Li  1 , Rongqiang Liu  1 , Haizhou Qiu  2 , Yang Huang  2 , Wenbin Liu  1 , Jiaxin Li  2 , Hong Wu  2 , Genshu Wang  3 , Dewei Li  1
Affiliations

Tumor Burden Score Stratifies Prognosis of Patients With Intrahepatic Cholangiocarcinoma After Hepatic Resection: A Retrospective, Multi-Institutional Study

Hui Li et al. Front Oncol. .

Abstract

Background: The prognostic significance of tumor burden score (TBS) on patients who underwent curative-intent resection of intrahepatic cholangiocarcinoma (ICC) has not been evaluated. The present study aimed to investigate the impact of TBS and its synergistic effect with CA19-9 (combination of TBS and CA19-9, CTC grade) on long-term outcomes.

Methods: Patients who underwent radical resection of ICC between 2009 and 2017 were retrospectively identified from a multi-center database. The overall survival (OS) and recurrence-free survival (RFS) were examined in relation to TBS, serum preoperative CA19-9, and CTC grade.

Results: A total of 650 patients were included in our study (509 in the derivation cohort and 141 in the validation cohort). Kaplan-Meier curves showed that both TBS and CA19-9 levels were strong predictors of survival outcomes. Patients with elevated TBS grade or elevated CA19-9 were associated with worse OS and RFS (both p < 0.001). As expected, CTC grade also performed well in predicting long-term outcomes. Patients with low TBS/low CA19-9 (CTC grade 1) were associated with the best OS as well as RFS, while high TBS/high CA19-9 (CTC grade 3) correlated to the worst outcomes. In the validation cohort, TBS grade, preoperative CA19-9, and CTC grade also stratified prognosis among patients (p < 0.001 for each).

Conclusions: Both tumor morphology (tumor burden) and tumor-specific biomarker (serum CA19-9) were important when evaluating prognosis of patients with resectable ICC. Serum CA19-9 and TBS showed a synergistic effect on prognostic evaluation. CTC grade was a promising tool in stratifying prognosis of ICC patients after curative resection.

Keywords: CA19-9; hepatectomy; intrahepatic cholangiocarcinoma; prognosis; tumor burden score.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The selection process of ICC patients in the final analysis. ICC, intrahepatic cholangiocarcinoma.
Figure 2
Figure 2
Kaplan–Meier curves for OS and RFS stratified by TBS (A, D), CA19-9 (B, E), and CTC grade (C, F) in the derivation cohort. OS, overall survival; RFS, relapse-free survival.
Figure 3
Figure 3
Comparison of the predictive value of TBS, CA19-9, and CTC grade in OS (A) and DFS (B) in the derivation cohort.
Figure 4
Figure 4
Kaplan–Meier curves for OS and RFS stratified by TBS (A, D), CA19-9 (B, E), and CTC grade (C, F) in the validation cohort.
See this image and copyright information in PMC

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