Liver Int. 2014 Jul;34(6):953-60. doi: 10.1111/liv.12364. Epub 2013 Nov 20.
Staging, prognostic factors and adjuvant therapy of intrahepatic cholangiocarcinoma after curative resection.
Li T, Qin LX, Zhou J, Sun HC, Qiu SJ, Ye QH, Wang L, Tang ZY, Fan J.
Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China.
BACKGROUND AND AIMS:
Prognostic factors and adjuvant therapy of intrahepatic cholangiocarcinoma (ICC) after curative resection were not clear. We aim to analyze prognostic factors after curative resection and evaluate adjuvant therapy and survival based on the new staging system.
A retrospective analysis of 283 patients who underwent surgical exploration for ICC was performed. Staging was performed according to the 7th edition AJCC staging manual. Univariate and multivariate analyses were used to evaluate independent prognostic factors.
The difference for OS at different TNM stages after R0 resection was significant (p<0.001). Despite regional lymph node metastasis, tumor number and vascular invasion, serum GGT level was also an independent prognostic factor for OS of patients after R0 resection. The incidence of biliary and vascular invasion was significantly higher in high GGT group than in normal GGT group. Factors predictive of recurrence were multiple tumors and regional lymph node metastasis. After R0 resection, adjuvant TACE not only did not improve the OS of patients at TNM stage I (p=0.508), but significantly promoted recurrence of these patients (p=0.006). Only patients at TNM stage II, III and IV benefited from adjuvant TACE for longer survival, while the recurrence rates were not affected.
The new staging system can predict the survival of ICC patients after R0 resection. High GGT level may be suggestive of biliary and vascular invasion and was an independent risk factor for OS after R0 resection. Adjuvant TACE may be indicated only for patients at advanced stages for better survival.