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Implications of Intrahepatic Cholangiocarcinoma Etiology on Recurrence and Prognosis after Curative-Intent Resection: a Multi-Institutional Study.
- Source :
-
World Journal of Surgery . Mar2018, Vol. 42 Issue 3, p849-857. 9p. 3 Charts, 3 Graphs. - Publication Year :
- 2018
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Abstract
- Background: We sought to investigate the prognosis of patients following curative-intent surgery for intrahepatic cholangiocarcinoma (ICC) stratified by hepatitis B (HBV-ICC), hepatolithiasis (Stone-ICC), and no identifiable cause (conventional ICC) etiologic subtype.Methods: 986 patients with HBV-ICC (<italic>n</italic> = 201), stone-ICC (<italic>n</italic> = 103), and conventional ICC (<italic>n</italic> = 682) who underwent curative-intent resection were identified from a multi-institutional database. Propensity score matching (PSM) was used to mitigate residual bias.Results: HBV-ICC patients more often had cirrhosis, earlier stage tumors, a mass-forming lesion, well-to-moderate tumor differentiation, and an R0 resection versus stone-ICC or conventional ICC patients. Five-year recurrence-free survival among HBV-ICC and conventional ICC patients was 23.9 and 17.8%, respectively, versus a recurrence-free of only 8.3% among patients with stone-ICC. Similarly, 5-year overall survival among patients with stone-ICC was only 18.3% compared with 48.9 and 38.0% for patients with HBV-ICC and conventional ICC, respectively. On PSM, patients with stone-ICC group had equivalent long-term outcomes as HBV-ICC patients. In contrast, on PSM, stone-ICC patients had a median overall survival of only 18.0 months versus 44.0 months for patients with conventional ICC. Median overall survival after intrahepatic-only recurrence among patients who had stone-ICC (6.0 months) was worse than OS among HBV-ICC (13.0 months) or conventional ICC (12.0 months) (<italic>p</italic> = 0.006 and <italic>p</italic> = 0.082, respectively).Conclusions: While HBV-ICC had a better prognosis on unadjusted analyses, these differences were mitigated on PSM suggesting no stage-for-stage differences in outcomes compared with stone-ICC or conventional ICC. In contrast, patients with stone-ICC had worse long-term outcomes. These data highlight the relative importance of ICC etiology relative to established clinicopathological factors in the prognosis of patients with ICC. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 03642313
- Volume :
- 42
- Issue :
- 3
- Database :
- Academic Search Index
- Journal :
- World Journal of Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 127845470
- Full Text :
- https://doi.org/10.1007/s00268-017-4199-9