Predicting risk of recurrence after resection of stage I intrahepatic cholangiocarcinoma

Jun Kawashima, Kota Sahara, Feng Shen, Alfredo Guglielmi, Luca Aldrighetti, Matthew Weiss, Todd W. Bauer, Sorin Alexandrescu, George A. Poultsides, Shishir K. Maithel, Hugo P. Marques, Guillaume Martel, Carlo Pulitano, François Cauchy, B. Groot Koerkamp, Ryusei Matsuyama, Itaru Endo, Timothy M. Pawlik*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)

Abstract

BACKGROUND: 

Early-stage intrahepatic cholangiocarcinoma (ICC) is often an indication of curative-intent resection. Although patients with early-stage ICC generally have a better prognosis than individuals with advanced ICC, the incidence and risk factors of recurrence after early-stage ICC remain unclear. 

METHODS: 

A multi-institutional database was used to identify patients who underwent surgery between 2000 and 2018 for ICC with pathologically confirmed stage I disease. Cox regression analysis was used to identify clinicopathological factors associated with recurrence, and an online prediction model was developed and validated. 

RESULTS: 

Of 430 patients diagnosed with stage I ICC, approximately one-half of patients (n = 221, 51.4%) experienced recurrence after curative-intent resection. Among patients with a recurrence, most (n = 188, 85.1%) experienced it within 12 months. On multivariable analysis, carcinoembryonic antigen (hazard ratio [HR], 1.011; 95% CI, 1.004-1.018), systemic immune-inflammation index (HR, 1.036; 95% CI, 1.019-1.056), no lymph nodes evaluated (HR, 1.851; 95% CI, 1.276-2.683), and tumor size (HR, 1.101; 95% CI, 1.053-1.151) were associated with greater hazards of recurrence. A predictive model that included these weighted risk factors demonstrated excellent prognostic discrimination in the test (12-month recurrence-free survival [RFS]: low risk, 80.1%; intermediate risk, 60.3%; high risk, 37.7%; P = .001) and validation (12-month RFS: low risk, 84.5%; intermediate risk, 63.5%; high risk, 47.1%; P = .036) datasets. The online predictive model was made available at https://ktsahara.shinyapps.io/stageI_icc/. 

CONCLUSIONS: 

Patients with stage I ICC without vascular invasion or lymph node metastasis had a relatively high incidence of recurrence. An online tool can risk stratify patients relative to recurrence risk to identify individuals best suited for alternative treatment approaches.

Original languageEnglish
Pages (from-to)18-25
Number of pages8
JournalJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
Volume28
Issue number1
DOIs
Publication statusPublished - Jan 2024

Bibliographical note

Publisher Copyright:
© 2023 Society for Surgery of the Alimentary Tract

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