Can hepatic resection provide a long‐term cure for patients with intrahepatic cholangiocarcinoma?

Abstract

BACKGROUND: A patient can be considered statistically cured from a specific disease when their mortality rate returns to the same level as that of the general population. In the current study, the authors sought to assess the probability of being statistically cured from intrahepatic cholangiocarcinoma (ICC) by hepatic resection. METHODS: A total of 584 patients who underwent surgery with curative intent for ICC between 1990 and 2013 at 1 of 12 participating institutions were identified. A nonmixture cure model was adopted to compare mortality after hepatic resection with the mortality expected for the general population matched by sex and age. RESULTS: The median, 1-year, 3-year, and 5-year disease-free survival was 10 months, 44%, 18%, and 11%, respectively; the corresponding overall survival was 27 months, 75%, 37%, and 22%, respectively. The probability of being cured of ICC was 9.7% (95% confidence interval, 6.1%-13.4%). The mortality of patients undergoing surgery for ICC was higher than that of the general population until year 10, at which time patients alive without tumor recurrence can be considered cured with 99% certainty. Multivariate analysis demonstrated that cure probabilities ranged from 25.8% (time to cure, 9.8 years) in patients with a single, well-differentiated ICC measuring 5 cm that was without vascular/periductal invasion and lymph nodes metastases versus <0.1% (time to cure, 12.6 years) among patients with all 6 of these risk factors. A model with which to calculate cure fraction and time to cure was developed. CONCLUSIONS: The cure model indicated that statistical cure was possible in patients undergoing hepatic resection for ICC. The overall probability of cure was approximately 10% and varied based on several tumor-specific factors. Cancer 2015;121:3998-4006.

Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi‐institutional analysis

“…Operative intervention for ICC can be technically challenging and complex. Frequently patients present with advanced disease that requires a major hepatic resection . In some instances, the ICC mass may involve a major vascular structure such as the PV or ICC.…”

“…While patients with unresectable disease have a 5‐year survival of 5‐10%, 5‐year survival among patients after curative surgery ranges from 35% to 50% . Spolverato et al have even suggested that true “cure” may be possible in approximately 10% of patients following surgical resection . Several prognostic factors including tumor multi‐centricity, poor differentiation, lymphatic metastasis, and surgical margin status may explain the heterogeneity in prognosis …”

Intrahepatic cholangiocarcinoma: Epidemiology, risk factors, diagnosis and surgical management

“…In a recent multicenter study enrolling 584 patients who underwent resection for ICC, the overall probability of cure was 9.7% (95% CI, 6.1%-13.4%), which was higher (25.8%) in patients with single, well-differentiated small (≤ 5 cm) lesions and without vascular/periductal invasion and node metastases [65] . Even in selected candidates with younger Page 10 of 36 age and earlier-stage lesions, R0 resection can only be achieved in less than 30% of patients [66] .…”

Defining the Chance of Statistical Cure Among Patients with Extrahepatic Biliary Tract Cancer

“…These data serve to emphasize the marked differences in both chances of cure and the time to assuming a 99 % level of cure confidence. In general, results reported herein for patients with extrahepatic biliary tract cancers were slightly better than the 10 % overall chance of cure for patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) [22]. Moreover, when patients with ICC were compared to patients with PHCC or GBC, the cure probability was 25.8 versus 30.1 %, respectively, among patients with favorable prognostic factors.…”

“…In a separate study, investigators evaluated the cure fraction of patients with liver and pancreatic cancers [21]. Our own group has also previously assessed the probability of being statistically cured from intrahepatic cholangiocarcinoma among a large cohort of patients undergoing curative-intent surgery [22]. However, the chance of statistical cure among patients with extrahepatic biliary tract cancers remains undefined.…”