Anatomical Resection Improved the Outcome of Intrahepatic Cholangiocarcinoma: A Propensity Score Matching Analysis of a Retrospective Cohort

Abstract

Background. Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignancy after hepatocellular carcinoma (HCC), with a dismal prognosis and high heterogeneity. The oncological advantages of anatomical resection (AR) and nonanatomical resection (NAR) in HCC have been studied, but surgical strategies for ICC remain controversial with insufficient investigations. Materials and Methods. From Jan 2013 to Dec 2016, 3880 consecutive patients were retrospectively reviewed from a single center. Patients with ICC undergoing AR or NAR have been enrolled according to inclusion and exclusion criteria. Propensity score matching (PSM) analysis was performed between two groups with a 1 : 1 ratio. The primary endpoint was overall survival (OS), and the secondary endpoints included disease-free survival (DFS), intraoperative patterns, postoperative morbidity, mortality, complications and recurrence. A prognostic nomogram was developed by a multivariate Cox proportion hazard model. Results. After PSM, 99 paired cases were selected from 276 patients enrolled in this study. Patients in the AR group achieved better 1-, 3-, and 5-year OS (70%, 46%, and 34%, respectively) and DFS (61%, 21%, and 10%, respectively) than patients in the NAR group with statistical significance after PSM analysis. The postoperative complications and recurrence patterns were comparable between the two groups. Multivariate analysis identified NAR, tumor size >5 cm, multiple tumors, and poor differentiation as independent risk factors for OS ( p < 0.05 ). Selected patients can benefit most from AR, according to subgroup analysis. A prognostic nomogram based on six independent risk factors for OS and factors with clinical significance was constructed to predict OS in ICC patients. Conclusion. AR improved the long-term survival of ICC with comparable postoperative complications and similar recurrence patterns. AR is suggested in ICC patients with sufficient remnant liver volume. In addition to surgery strategy, malignant characteristics of tumors are risk factors for ICC prognosis.

New Insights into Surgical Management of Intrahepatic Cholangiocarcinoma in the Era of “Transplant Oncology”

“…Similarly, anatomic liver resection should be preferred in cases of iCCA in which the future liver remnant is sufficient. Hence, as reported in two recent large Chinese studies [34,35], this approach showed advantages in terms of OS and DFS, as well as no differences in the post-operative complications rate, compared to non-anatomical resection.…”

A narrative review of intrahepatic cholangiocarcinoma: a surgical curative option

“…The oncological advantage of ALR is confirmed in another recent, large, Chinese single-centre experience on 3,880 patients (30). The results demonstrate that AR improved long-term survival in terms of 1-, 3-and 5-year OS (70%, 46% and 34%, respectively) and a DFS (61%; 21%and 10%, respectively) with a statistical significance after PSM analysis.…”

Anatomic versus non-anatomic resection for early-stage intrahepatic cholangiocarcinoma: a propensity score matching and stabilized inverse probability of treatment weighting analysis

“…A comprehensive literature search was conducted in databases including PubMed, Embase, the Cochrane Library, Medline, and Web of Science to identify relevant studies evaluating the potential benefits of AR for ICC patients. Ultimately, as presented in Supplementary Table 3 , a total of six studies encompassing 1523 patients were included in the analysis [ 13 , 14 , 19 , 31 – 33 ], with 764 patients allocated to the AR group and 759 patients allocated to the NAR group. The findings from five studies collectively indicated a favorable effect of AR on the prognosis of ICC, along with reduced rates of postoperative recurrence [ 13 , 14 , 31 – 33 ].…”

“…Ultimately, as presented in Supplementary Table 3 , a total of six studies encompassing 1523 patients were included in the analysis [ 13 , 14 , 19 , 31 – 33 ], with 764 patients allocated to the AR group and 759 patients allocated to the NAR group. The findings from five studies collectively indicated a favorable effect of AR on the prognosis of ICC, along with reduced rates of postoperative recurrence [ 13 , 14 , 31 – 33 ]. Conversely, the outcomes of the remaining study indicated that the implementation of AR did not yield improvements in prognosis among patients with solitary ICC that lacked direct invasion of adjacent organs or extrahepatic metastases [ 19 ].…”