Xu-Feng Zhang1,2, Jeffery Chakedis2, Fabio Bagante3, Eliza W Beal2, Yi Lv1, Matthew Weiss4, Irinel Popescu5, Hugo P Marques6, Luca Aldrighetti7, Shishir K Maithel8, Carlo Pulitano9, Todd W Bauer10, Feng Shen11, George A Poultsides12, Oliver Soubrane13, Guillaume Martel14, B Groot Koerkamp15, Alfredo Guglielmi3, Endo Itaru16, Timothy M Pawlik17. 1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 2. Department of Surgery, The Ohio State University, Wexner Medical Center, 395 W. 12th Avenue, Suite 670, Columbus, OH, USA. 3. Department of Surgery, University of Verona, Verona, Italy. 4. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 5. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 6. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 7. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 8. Department of Surgery, Emory University, Atlanta, GA, USA. 9. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 10. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 11. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 12. Department of Surgery, Stanford University, Stanford, CA, USA. 13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France. 14. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 15. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. 16. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan. 17. Department of Surgery, The Ohio State University, Wexner Medical Center, 395 W. 12th Avenue, Suite 670, Columbus, OH, USA. tim.pawlik@osumc.edu.
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 (n = 201), stone-ICC (n = 103), and conventional ICC (n = 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) (p = 0.006 and p = 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.
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 (n = 201), stone-ICC (n = 103), and conventional ICC (n = 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-ICCpatients 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) (p = 0.006 and p = 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.
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