Advertisement

Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3719–3727 | Cite as

Patterns of Distribution of Hepatic Nodules (Single, Satellites or Multifocal) in Intrahepatic Cholangiocarcinoma: Prognostic Impact After Surgery

  • Simone Conci
  • Andrea Ruzzenente
  • Luca Viganò
  • Giorgio Ercolani
  • Andrea Fontana
  • Fabio Bagante
  • Francesca Bertuzzo
  • Andrea Dore
  • Antonio Daniele Pinna
  • Guido Torzilli
  • Calogero Iacono
  • Alfredo Guglielmi
Hepatobiliary Tumors
  • 129 Downloads

Abstract

Objective

We aimed to compare the clinicopathological features and survival after surgery of patients with intrahepatic cholangiocarcinoma (ICC) according to the patterns of distribution of hepatic nodules.

Methods

A retrospective analysis of a multi-institutional series of 259 patients with resected ICC was carried out. Patients were further classified according to the pattern of distribution of hepatic nodules: single tumors (type I), single tumors with satellites in the same liver segment (type II), or multifocal tumors (type III).

Results

Overall, 64.5% of patients had type I, 21.9% had type II, and 13.5% had type III. The 5-year overall survival rate was 49.4, 34.2, and 9.9% for types I, II, and III, respectively (p < 0.001). A multivariate survival analysis identified the following independent prognostic factors: pattern types II and III (p = 0.001 and p = 0.001, respectively), size ≥ 50 mm (p = 0.021), lymph node (LN) metastases (p = 0.005), and R1 resections (p = 0.019). We stratified survival for each type of pattern according to the other prognostic factors identified in the multivariate analysis. N0 and R0 patients with type II and III tumors had encouraging long-term results. Conversely, patients with LN metastases and R1 resections had poor prognosis, particularly patients with type III tumors.

Conclusion

ICC has distinct patterns of distribution with different prognoses that should be considered when making therapeutic decisions. Patients with type III tumors had a significantly worse prognosis, and the benefits of upfront surgery should be carefully evaluated.

Notes

Conflict of interest

Simone Conci, Andrea Ruzzenente, Luca Viganò, Giorgio Ercolani, Andrea Fontana, Fabio Bagante, Francesca Bertuzzo, Andrea Dore, Antonio Daniele Pinna, Guido Torzilli, Calogero Iacono and Alfredo Guglielmi have no conflict of interest to declare.

Supplementary material

10434_2018_6669_MOESM1_ESM.docx (83 kb)
Supplementary material 1 (DOCX 82 kb)
10434_2018_6669_MOESM2_ESM.pptx (1.2 mb)
Supplementary material 2 (PPTX 1267 kb)

References

  1. 1.
    Miyazaki M, Ohtsuka M, Miyakawa S et al. Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3rd English edition. J Hepatobiliary Pancreat Sci. 2015;22(3):181–96.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Aljiffry M, Abdulelah A, Walsh M, Peltekian K, Alwayn I, Molinari M. Evidence-based approach to cholangiocarcinoma: a systematic review of the current literature. J Am Coll Surg. 2009;208(1):134–47.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Herszenyi L, Tulassay Z. Epidemiology of gastrointestinal and liver tumors. Eur Rev Med Pharmacol Sci. 2010;14(4):249–58.PubMedGoogle Scholar
  4. 4.
    Khan SA, Taylor-Robinson SD, Toledano MB, Beck A, Elliott P, Thomas HC. Changing international trends in mortality rates for liver, biliary and pancreatic tumours. J Hepatol. 2002;37(6):806–13.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Njei B. Changing pattern of epidemiology in intrahepatic cholangiocarcinoma. Hepatology. 2014;60(3):1107–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Zhang H, Yang T, Wu M, Shen F. Intrahepatic cholangiocarcinoma: epidemiology, risk factors, diagnosis and surgical management. Cancer Lett. 2016;379(2):198–205.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Ribero D, Pinna AD, Guglielmi A et al. Surgical approach for long-term survival of patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis of 434 patients. Arch Surg. 2012;147(12):1107–13.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ruzzenente A, Conci S, Valdegamberi A, Pedrazzani C, Guglielmi A. Role of surgery in the treatment of intrahepatic cholangiocarcinoma. Eur Rev Med Pharmacol Sci. 2015;19(15):2892–900.PubMedGoogle Scholar
  9. 9.
    Guglielmi A, Ruzzenente A, Campagnaro T et al. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg. 2009;33(6):1247–54.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Jonas S, Thelen A, Benckert C et al. Extended liver resection for intrahepatic cholangiocarcinoma: a comparison of the prognostic accuracy of the fifth and sixth editions of the TNM classification. Ann Surg. 2009;249(2):303–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Spolverato G, Kim Y, Alexandrescu S et al. Is hepatic resection for large or multifocal intrahepatic cholangiocarcinoma justified? Results from a multi-institutional collaboration. Ann Surg Oncol. 2015;22(7):2218–25.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hwang S, Lee YJ, Song GW et al. Prognostic impact of tumor growth type on 7th AJCC staging system for intrahepatic cholangiocarcinoma: a single-center experience of 659 cases. J Gastrointest Surg. 2015;19(7):1291–304.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Wright GP, Perkins S, Jones H et al. Surgical resection does not improve survival in patients with multifocal Intrahepatic Cholangiocarcinoma: a comparison of surgical resection with intra-arterial therapy. Ann Surg Oncol. 2018;25(1):83–90.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bagante F, Gani F, Spolverato G et al. Intrahepatic Cholangiocarcinoma: Prognosis of Patients Who Did Not Undergo Lymphadenectomy. J Am Coll Surg. 2015;221(6):1031-40.e1-4.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Amin MB, Edge SB, Green FL, et al. editors. American Joint Committee on Cancer (AJCC). Cancer staging manual. 8th edn. New York: Springer; 2017.Google Scholar
  16. 16.
    Baheti AD, Tirumani SH, Shinagare AB, Rosenthal MH, Hornick JL, Ramaiya NH, et al. Correlation of CT patterns of primary intrahepatic cholangiocarcinoma at the time of presentation with the metastatic spread and clinical outcomes: retrospective study of 92 patients. Abdom Imaging. 2014;39(6):1193–201.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ruzzenente A, Conci S, Ciangherotti A, et al. Impact of age on short-term outcomes of liver surgery: lessons learned in 10-years’ experience in a tertiary referral hepato-pancreato-biliary center. Medicine (Baltimore). 2017;96(20):e6955.CrossRefGoogle Scholar
  18. 18.
    Doussot A, Lim C, Gomez Gavara C, et al. Multicentre study of the impact of morbidity on long-term survival following hepatectomy for intrahepatic cholangiocarcinoma. Br J Surg. 2016;103(13):1887–1894.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Reames BN, Bagante F, Ejaz A, et al. Impact of adjuvant chemotherapy on survival in patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis. HPB (Oxford). 2017;19:901–909.CrossRefGoogle Scholar
  20. 20.
    Uenishi T, Kubo S, Yamazaki O, Yamada T, Sasaki Y, Nagano H, Monden M. Indications for surgical treatment of intrahepatic cholangiocarcinoma with lymph node metastases. J Hepatobiliary Pancreat Surg. 2008;15:417–422.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Simone Conci
    • 1
  • Andrea Ruzzenente
    • 1
  • Luca Viganò
    • 2
  • Giorgio Ercolani
    • 3
  • Andrea Fontana
    • 2
  • Fabio Bagante
    • 1
  • Francesca Bertuzzo
    • 1
  • Andrea Dore
    • 1
  • Antonio Daniele Pinna
    • 3
  • Guido Torzilli
    • 2
  • Calogero Iacono
    • 1
  • Alfredo Guglielmi
    • 1
  1. 1.Division of General and Hepatobiliary Surgery, Department of Surgery, G.B, Rossi University HospitalUniversity of VeronaVeronaItaly
  2. 2.Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research CenterHumanitas UniversityRozzano, MilanItaly
  3. 3.Department of General and Emergency Surgery and Organ Transplantation, S. Orsola-Malpighi HospitalUniversity of BolognaBolognaItaly

Personalised recommendations