Recurrence patterns and disease-free survival after resection of intrahepatic cholangiocarcinoma: Preoperative and postoperative prognostic models Journal Article
| Authors: | Doussot, A.; Gonen, M.; Wiggers, J. K.; Groot-Koerkamp, B.; DeMatteo, R. P.; Fuks, D.; Allen, P. J.; Farges, O.; Kingham, T. P.; Regimbeau, J. M.; D'Angelica, M. I.; Azoulay, D.; Jarnagin, W. R. |
| Article Title: | Recurrence patterns and disease-free survival after resection of intrahepatic cholangiocarcinoma: Preoperative and postoperative prognostic models |
| Abstract: | Background Liver resection is the most effective treatment for intrahepatic cholangiocarcinoma. Recurrent disease is frequent; however, recurrence patterns are ill-defined and prognostic models are lacking. Study Design A primary cohort of 189 patients who underwent resection for intrahepatic cholangiocarcinoma was used for recurrence patterns analysis within and after 24 months. Based on independent factors for disease-free survival identified in Cox regression analysis, preoperative and postoperative models were developed using a recursive partitioning method. Models were externally validated using a multicenter cohort of 522 resected patients (Association Française de Chirurgie intrahepatic cholangiocarcinoma study group). Results Recurrence within 24 months most often involved the liver (82.7%), and most recurrences after 24 months were strictly extrahepatic (61.1%). In multivariable analysis of the primary cohort, independent preoperative factors for disease-free survival were tumor size and multifocality (based on imaging); tumor size, multifocality, vascular invasion, and lymph node metastases (based on pathology) were independent postoperative factors. The preoperative model allowed patient classification into low-risk and high-risk groups for recurrence. In the validation cohort (n = 522), high-risk patients had a greater likelihood of recurrence (hazard ratio = 2.17; 95% CI, 1.74–2.72; p < 0.001). The postoperative model included tumor size, vascular invasion, and positive nodal disease on pathology and classified patients in low-, intermediate-, and high-risk groups in the primary cohort. As compared with low-risk patients in the validation cohort, intermediate- and high-risk patients were more likely to experience recurrence (hazard ratio = 1.9; 95% CI, 1.41–2.47; p < 0.001 and hazard ratio = 2.99; 95% CI, 2.08–4.31; p < 0.001, respectively). Conclusions Recurrence patterns are time dependent. Both models as developed and validated in this study classified patients in distinct recurrence risk groups, which can guide treatment recommendations. © 2016 American College of Surgeons |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 223 |
| Issue: | 3 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2016-09-01 |
| Start Page: | 493 |
| End Page: | 505 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2016.05.019 |
| PROVIDER: | scopus |
| PMCID: | PMC5003652 |
| PUBMED: | 27296525 |
| DOI/URL: | |
| Notes: | Conference Paper -- Export Date: 3 January 2017 -- Source: Scopus |
Altmetric
Citation Impact
MSK Authors
Related MSK Work