Efficacy of surgical management for recurrent intrahepatic cholangiocarcinoma: A multi-institutional study by the Okayama Study Group of HBP surgery

Kojima, Toru; Umeda, Yuzo; Fuji, Tomokazu; Niguma, Takefumi; Sato, Daisuke; Endo, Yoshikatsu; Sui, Kenta; Inagaki, Masaru; Oishi, Masahiro; Ota, Tetsuya; Hioki, Katsuyoshi; Matsuda, Toshihiko; Aoki, Hideki; Hirai, Ryuji; Kimura, Masashi; Yagi, T.; Fujiwara, Toshiyoshi

doi:10.1371/journal.pone.0238392

Cited by 12 publications

(16 citation statements)

References 36 publications

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“…Zhang et al (11) revealed that the patterns of early recurrence (≤2 years) and late recurrence were different, and early recurrence of extrahepatic recurrence was more common, whereas late recurrence was often only intrahepatic recurrence. Importantly, patients' recurrence within 1 year after surgery may represent more aggressive tumor biology, and a cutoff of 1 year after surgery has been used to distinguish the early recurrence and late recurrence in most studies (10,17,20,21). Wang et al (20) showed that specific risk factors, including CA 19-9, microvascular invasion, and multiple tumors, may relate to the early recurrence of ICC after curative resection.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, identifying patients who are at risk for early recurrence is important to construct individualized surveillance strategies for ICC patients after radical resection. Recently, more and more scholars are concerned about the risk factors of early recurrence, while the definition of early recurrence is different because definitive guidelines do not exist (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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A Nomogram Model to Predict Early Recurrence of Patients With Intrahepatic Cholangiocarcinoma for Adjuvant Chemotherapy Guidance: A Multi-Institutional Analysis

Zhang

Chen

et al. 2022

Front. Oncol.

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BackgroundThe influence of different postoperative recurrence times on the efficacy of adjuvant chemotherapy (ACT) for intrahepatic cholangiocarcinoma (ICC) remains unclear. This study aimed to investigate the independent risk factors and establish a nomogram prediction model of early recurrence (recurrence within 1 year) to screen patients with ICC for ACT.MethodsData from 310 ICC patients who underwent radical resection between 2010 and 2018 at eight Chinese tertiary hospitals were used to analyze the risk factors and establish a nomogram model to predict early recurrence. External validation was conducted on 134 patients at the other two Chinese tertiary hospitals. Overall survival (OS) and relapse-free survival (RFS) were estimated by the Kaplan–Meier method. Multivariate analysis was conducted to identify independent risk factors for prognosis. A logistic regression model was used to screen independent risk variables for early recurrence. A nomogram model was established based on the above independent risk variables to predict early recurrence.ResultsACT was a prognostic factor and an independent affecting factor for OS and RFS of patients with ICC after radical resection (p < 0.01). The median OS of ICC patients with non-ACT and ACT was 14.0 and 15.0 months, and the median RFS was 6.0 and 8.0 months for the early recurrence group, respectively (p > 0.05). While the median OS of ICC patients with non-ACT and ACT was 41.0 and 84.0 months, the median RFS was 20.0 and 45.0 months for the late recurrence group, respectively (p < 0.01). CA19-9, tumor size, major vascular invasion, microvascular invasion, and N stage were the independent risk factors of early recurrence for ICC patients after radical resection. The C-index of the nomogram was 0.777 (95% CI: 0.713~0.841) and 0.716 (95%CI: 0.604~0.828) in the training and testing sets, respectively.ConclusionThe nomogram model established based on the independent risk variables of early recurrence for curatively resected ICC patients has a good prediction ability and can be used to screen patients who benefited from ACT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Nomogram Model to Predict Early Recurrence of Patients With Intrahepatic Cholangiocarcinoma for Adjuvant Chemotherapy Guidance: A Multi-Institutional Analysis

Zhang

Chen

et al. 2022

Front. Oncol.

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“…In a multi-center Japanese study, the re-resection rate was 31% for patients with intrahepatic-only recurrences occurring after a year from the initial operation. For patients with earlier recurrences, repeat surgery was performed in only 6.8% (132). Table 3 presents survival data after reresection of iCCA liver recurrences.…”

Section: Repeat Hepatectomymentioning

confidence: 99%

Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature

2022

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Recurrence following curative-intent hepatectomy for colorectal cancer liver metastasis, hepatocellular carcinoma, or cholangiocarcinoma is unfortunately common with a reported incidence as high as 75%. Various treatment modalities can improve survival following disease recurrence. A review of the literature was performed using PubMed. In addition to systemic therapy, liver-directed treatment options for recurrent liver disease include repeat hepatectomy, salvage liver transplantation, radiofrequency or microwave ablation, intra-arterial therapy, and stereotactic body radiation therapy. Repeat resection can be consider for patients with limited recurrent disease that meets resection criteria, as this therapeutic approach can provide a survival benefit and is potentially curative in a subset of patients. Salvage liver transplantation for recurrent hepatocellular carcinoma is another option, which has been associated with a 5-year survival of 50%. Salvage transplantation may be an option in particular for patients who are not candidates for resection due to underlying liver dysfunction but meet criteria for transplantation. Ablation is another modality to treat patients who recur with smaller tumors and are not surgical candidates due to comorbidity, liver dysfunction, or tumor location. For patients with inoperable disease, transarterial chemoembolization, or radioembolization with Yttrium-90 are liver-directed intra-arterial therapy modalities with relatively low risks that can be utilized. Stereotactic body radiation therapy is another palliative treatment option that can provide a response and local tumor control for smaller tumors.

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“…The main reason for the unfavorable outcome is the high incidence of recurrence [ 8 ]. Approximately 37.9–60% of patients occur local recurrence and/or distant metastases within 1 year after resection, with a median overall survival (OS) as low as 16.3 months [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

DWI-based radiomic signature: potential role for individualized adjuvant chemotherapy in intrahepatic cholangiocarcinoma after partial hepatectomy

et al. 2022

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Objectives To develop a diffusion-weighted imaging (DWI) based radiomic signature for predicting early recurrence (ER) (i.e., recurrence within 1 year after surgery), and to explore the potential value for individualized adjuvant chemotherapy. Methods A total of 124 patients with intrahepatic cholangiocarcinoma (ICC) were randomly divided into the training (n = 87) and the validation set (n = 37). Radiomic signature was built using radiomic features extracted from DWI with random forest. An integrated radiomic nomogram was constructed with multivariate logistic regression analysis to demonstrate the incremental value of the radiomic signature beyond clinicopathological-radiographic factors. A clinicopathological-radiographic (CPR) model was constructed as a reference. Results The radiomic signature showed a comparable discrimination performance for predicting ER to CPR model in the validation set (AUC, 0.753 vs. 0.621, p = 0.274). Integrating the radiomic signature with clinicopathological-radiographic factors further improved prediction performance compared with CPR model, with an AUC of 0.821 (95%CI 0.684–0.959) in the validation set (p = 0.01). The radiomic signature succeeded to stratify patients into distinct survival outcomes according to their risk index of ER, and remained an independent prognostic factor in multivariable analysis (disease-free survival (DFS), p < 0.0001; overall survival (OS), p = 0.029). Furthermore, adjuvant chemotherapy improved prognosis in high-risk patients defined by the radiomic signature (DFS, p = 0.029; OS, p = 0.088) and defined by the nomogram (DFS, p = 0.031; OS, p = 0.023), whereas poor chemotherapy efficacy was detected in low-risk patients. Conclusions The preoperative DWI-based radiomic signature could improve prognostic prediction and help to identify ICC patients who may benefit from postoperative adjuvant chemotherapy.

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Efficacy of surgical management for recurrent intrahepatic cholangiocarcinoma: A multi-institutional study by the Okayama Study Group of HBP surgery

Cited by 12 publications

References 36 publications

A Nomogram Model to Predict Early Recurrence of Patients With Intrahepatic Cholangiocarcinoma for Adjuvant Chemotherapy Guidance: A Multi-Institutional Analysis

A Nomogram Model to Predict Early Recurrence of Patients With Intrahepatic Cholangiocarcinoma for Adjuvant Chemotherapy Guidance: A Multi-Institutional Analysis

Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature

DWI-based radiomic signature: potential role for individualized adjuvant chemotherapy in intrahepatic cholangiocarcinoma after partial hepatectomy

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