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Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

While tumor burden (TB) has been associated with outcomes among patients with hepatocellular carcinoma, the role of overall TB in intrahepatic cholangiocarcinoma (ICC) remains poorly defined.

Methods

Patients undergoing curative-intent resection of ICC between 2000 and 2017 were identified from a multi-institutional database. The impact of TB on overall (OS) and disease-free survival (DFS) was evaluated in the multi-institutional database and validated externally.

Results

Among 1101 patients who underwent curative-intent resection of ICC, 624 (56.7%) had low TB, 346 (31.4%) medium TB, and 131 (11.9%) high TB. OS incrementally worsened with higher TB (5-year OS; low TB: 48.3% vs medium TB: 29.8% vs high TB: 17.3%, p < 0.001). Similarly, patients with low TB had better DFS compared with medium and high TB patients (5-year DFS: 38.3% vs 18.7% vs 6.9%, p < 0.001). On multivariable analysis, TB was independently associated with OS (medium TB: HR = 1.40, 95% CI 1.14–1.71; high TB: HR = 1.89, 95% CI 1.46–2.45) and DFS (medium TB, HR = 1.61, 95% CI 1.33–1.96; high TB: HR = 2.03, 95% CI 1.56–2.64). Survival analysis revealed an excellent prognostic discrimination using the TB among the external validation cohort (3-year OS; low TB: 44.8%, medium TB: 29.3%; high TB: 23.3%, p = 0.03; 3-year DFS: low TB: 32.7%, medium TB: 10.7%; high TB: 0%, p < 0.001). While neoadjuvant chemotherapy was not associated with survival across the TB groups, receipt of adjuvant chemotherapy was associated with increased survival among patients with high TB (5-year OS: 24.4% vs 13.4%, p = 0.02).

Conclusion

Overall TB dictated prognosis among patients with resectable ICC. TB may be used as a tool to help guide post-resection treatment strategies.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Diamantis I. Tsilimigras MD, J. Madison Hyer MS, Anghela Z. Paredes MD, MPH, Dimitrios Moris MD, PhD, Kota Sahara MD & Timothy M. Pawlik MD, MPH, PhD, FACS

  2. Department of Surgery, University of Verona, Verona, Italy

    Alfredo Guglielmi MD

  3. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Luca Aldrighetti MD

  4. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

  5. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer MD

  6. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Sorin Alexandrescu MD

  7. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides MD

  8. Department of Surgery, Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD

  9. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD

  10. Department of Surgery, University of Ottawa, Ottawa, Canada

    Guillaume Martel MD

  11. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

    Carlo Pulitano MD

  12. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen MD

  13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France

    Olivier Soubrane MD

  14. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Bas Groot Koerkamp MD

  15. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan

    Itaru Endo MD, PhD

  16. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USA

    Kazunari Sasaki MD & Federico Aucejo MD

  17. Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Xu-Feng Zhang MD

Authors
  1. Diamantis I. Tsilimigras MD
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  2. J. Madison Hyer MS
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  3. Anghela Z. Paredes MD, MPH
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  4. Dimitrios Moris MD, PhD
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  5. Kota Sahara MD
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  6. Alfredo Guglielmi MD
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  7. Luca Aldrighetti MD
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  8. Matthew Weiss MD
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  9. Todd W. Bauer MD
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  11. George A. Poultsides MD
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  12. Shishir K. Maithel MD
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  13. Hugo P. Marques MD
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  14. Guillaume Martel MD
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  15. Carlo Pulitano MD
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  16. Feng Shen MD
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  17. Olivier Soubrane MD
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  18. Bas Groot Koerkamp MD
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  19. Itaru Endo MD, PhD
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  20. Kazunari Sasaki MD
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  21. Federico Aucejo MD
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  22. Xu-Feng Zhang MD
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  23. Timothy M. Pawlik MD, MPH, PhD, FACS
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS.

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This study was accepted as an Oral Presentation at the American College of Surgeons 106th Annual Clinical Congress, Scientific Forum, Chicago, IL, October 2020

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Tsilimigras, D.I., Hyer, J.M., Paredes, A.Z. et al. Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?. Ann Surg Oncol 28, 1970–1978 (2021). https://doi.org/10.1245/s10434-020-09393-7

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  • DOI: https://doi.org/10.1245/s10434-020-09393-7

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