Recurrence after operative management of intrahepatic cholangiocarcinoma.
(2013) Surgery — Vol. 153, n° 6, p. 811-818 (2013)
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- Introduction: Data on recurrence after operation for intrahepatic cholangiocarcinoma (ICC) are limited. We sought to investigate rates and patterns of recurrence in patients after operative intervention for ICC. Methods: We identified 301 patients who underwent operation for ICC between 1990 and 2011 from an international, multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed. Results: During the median follow up duration of 31 months (range 1-208), 53.5% developed a recurrence. Median RFS was 20.2 months and 5-year actuarial disease-free survival, 32.1%. The most common site for initial recurrence after operation of ICC was intrahepatic (n = 98; 60.9%), followed by simultaneous intra- and extrahepatic disease (n = 30; 18.6%); 33 (21.0%) patients developed extrahepatic recurrence only as the first site of recurrence. Macrovascular invasion (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.34-3.21; P <.001), nodal metastasis (HR, 1.55; 95% CI, 1.01-2.45; P =.04), unknown nodal status (HR, 1.57; 95% CI, 1.10-2.25; P =.04), and tumor size ≥5 cm (HR, 1.84; 95% CI, 1.28-2.65; P <.001) were independently associated with increased risk of recurrence. Patients were assigned a clinical score from 0 to 3 according to the presence of these risk factors. The 5-year RFS for patients with scores of 0, 1, 2, and 3 was 61.8%, 36.2%, 19.5%, and 9.6%, respectively. Conclusion: Recurrence after operative intervention for ICC was common. Disease recurred both at intra- and extrahepatic sites with roughly the same frequency. Factors such as lymph node metastasis, tumor size, and vascular invasion predict highest risk of recurrence. © 2013 Mosby, Inc. All rights reserved.
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Hyder, O., Hatzaras, I., Sotiropoulos, G. C., Paul, A., Alexandrescu, S., Marques, H., Pulitano, C., Barroso, E., Clary, B. M., Aldrighetti, L., Ferrone, C. R., Zhu, A. X., Bauer, T. W., Walters, D. M., Groeschl, R., Gamblin, T. C., Marsh, J. W., Nguyen, K. T., Turley, R., et al. (2013). Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery, 153(6), 811-818. https://doi.org/10.1016/j.surg.2012.12.005 (Original work published 2013)