Impact of tumor localization on the outcomes of surgery for an intrahepatic cholangiocarcinoma

Orimo, Tatsuya; Kamiyama, Toshiya; Mitsuhashi, Tomoko; Kamachi, Hirofumi; Yokoo, Hideki; Wakayama, Kenji; Shimada, Shingo; Nagatsu, Akito; Taketomi, Akinobu

doi:10.1007/s00535-018-1469-8

Cited by 25 publications

(23 citation statements)

References 24 publications

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“…Interestingly, on multivariate analysis the hilar involvement was not associated with survival, which was instead dictated by biological tumor characteristics, such as T stage, nodal status and tumor differentiation (1). Similar results were also reported by Orimo et al, who showed that hICC had more aggressive biological behavior with lower survival than pICC (5 years OS: 30.4% vs. 51.1%) (53).…”

Section: Postoperative Outcomes and Predictors Of Prognosissupporting

confidence: 76%

Resection for intrahepatic cholangiocellular cancer: new advances

Waisberg¹,

Pinheiro²,

Nacif³

et al. 2018

Transl. Gastroenterol. Hepatol

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Intrahepatic cholangiocarcinoma (ICC) is the second most prevalent primary liver neoplasm after hepatocellular carcinoma (HCC), corresponding to 10% to 15% of cases. Pathologies that cause chronic biliary inflammation and bile stasis are known predisposing factors for development of ICC. The incidence and cancer-related mortality of ICC is increasing worldwide. Most patients remain asymptomatic until advance stage, commonly presenting with a liver mass incidentally diagnosed. The only potentially curative treatment available for ICC is surgical resection. The prognosis is dismal for unresectable cases. The principle of the surgical approach is a margin negative hepatic resection with preservation of adequate liver remnant. Regional lymphadenectomy is recommended at time of hepatectomy due to the massive impact on outcomes caused by lymph node (LN) metastasis. Multicentric disease, tumor size, margin status and tumor differentiation are also important prognostic factors. Staging laparoscopy is warranted in high-risk patients to avoid unnecessary laparotomy. Exceedingly complex surgical procedures, such as major vascular, extrahepatic bile ducts and visceral resections, ex vivo hepatectomy and autotransplantation, should be implemented in properly selected patients to achieve negative margins. Neoadjuvant therapy may be used in initially unresectable lesions in order to downstage and allow resection. Despite optimal surgical management, recurrence is frustratingly high. Adjuvant chemotherapy with radiation associated with locoregional treatments should be considered in cases with unfavorable prognostic factors. Selected patients may undergo re-resection of tumor recurrence. Despite the historically poor outcomes of liver transplantation for ICC, highly selected patients with unresectable disease, especially those with adequate response to neoadjuvant therapy, may be offered transplant. In this article, we reviewed the current literature in order to highlight the most recent advances and recommendations for the surgical treatment of this aggressive malignancy.

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Section: Postoperative Outcomes and Predictors Of Prognosissupporting

confidence: 76%

Resection for intrahepatic cholangiocellular cancer: new advances

Waisberg¹,

Pinheiro²,

Nacif³

et al. 2018

Transl. Gastroenterol. Hepatol

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“…R0 resection can be achieved in most peripheral ICC, thus achieving a good prognosis. 19,20 Therefore, visceral peritoneum invasion may not have any survival impact on ICC patients. As a consequence, the T3 category was deleted from the 8th edition and the T category was regrouped in the new mTNM staging.…”

Section: Discussionmentioning

confidence: 99%

Modifications of the AJCC 8th edition staging system for intrahepatic cholangiocarcinoma and proposal for a new staging system by incorporating serum tumor markers

Cheng

Lei

et al. 2019

HPB

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Background: Several studies have noted that the discriminatory ability and stratification performance of the AJCC 8th edition staging system is not entirely satisfactory. We aimed to improve the American Joint Committee on Cancer (AJCC) 8th edition staging system for intrahepatic cholangiocarcinoma (ICC). Methods: A multicentric database from three Chinese mainland centers (n = 1601 patients) was used to modify the 8th edition staging system. This modified TNM (mTNM) staging system was then validated using the SEER database (n = 761 patients). A new TNM staging system, by incorporating serum tumor markers (TNMIS) into the mTNM staging system was then proposed. Results: The 8th edition staging system did not provide an adequate stratification of prognosis in the Chinese multicentric cohort. The mTNM staging system offered a better discriminatory capacity in the multicentric cohort than the original 8th edition. External validation in the SEER cohort showed that the mTNM staging system also had a good stratification performance. After further incorporating a serum marker stage into the mTNM staging, the TNMIS staging system was able to stratify prognosis even better. Conclusion: The proposed mTNM staging system resulted in better stratification performance and the TNMIS staging system provided even more accurate prognostic classification than the conventional TNM system.

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“…Moreover, patients with a higher NLR are more likely to develop LNM in malignant tumors, such as gastric cancer (33), colorectal cancer (34), esophageal cancer (35), and small cell lung cancer (36). Cumulative studies have shown that among HCC patients, the larger the tumor diameter is, the higher the probability of LNM (37), which may be related to the biological invasive ability of the tumor; this conclusion has also been con rmed in studies of malignant tumors such as intrahepatic cholangiocarcinoma (38) and gastric cancer (39).…”

Section: Discussionmentioning

confidence: 77%

Nomogram Based on Preoperative Clinical Characteristics to Predict the Risk of Lymph Node Metastasis in Hepatocellular Carcinoma

Wei¹,

S²,

Ren³

et al. 2020

Preprint

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Background: There are limitations in judging the occurrence of lymph node metastasis (LNM) in hepatocellular carcinoma (HCC) before surgery. The purpose of this study was to establish a preoperative nomogram for predicting the risk of LNM in HCC and to explore its clinical utility.Methods: A total of 195 HCC patients undergoing radical hepatectomy were retrospectively analyzed. According to the presence or absence of LNM, the patients were divided into two groups, and the clinical characteristics of the two groups were compared. Risk factors for LNM were assessed based on logistic regression, and a nomogram was established. The receiver operating characteristic (ROC) curve was used to calculate area under the curve (AUC) of the logistic regression model, and the predictive accuracy of the nomogram was evaluated by the concordance index (C-index). The clinical efficacy of the nomogram was detected by decision curve analysis (DCA).Results: Logistic analysis revealed hepatitis B surface antigen (HBsAg) (HR = 3.50, 95% CI, 1.30-9.42, P = 0.013), globulin (HR = 2.46, 95% CI, 1.05-5.75, P = 0.039), neutrophil to lymphocyte ratio (NLR) (HR = 7.64, 95% CI, 3.22-18.11, P < 0.001) and tumor size (HR = 3.86, 95% CI, 1.26-11.88 P = 0.018) were independent risk factors for lymph node metastasis in HCC. The nomogram was established based on the above 4 variables, and the AUC was 0.835 (95% CI, 0.780-0.890). The calibration curve showed that the model has good predictive ability, and DCA indicates good predictive effect.Conclusions: The nomogram established by analyzing the preoperative clinical characteristics is a simple tool that can predict the risk of lymph node metastasis in HCC patients and guide clinicians to make better clinical decisions.

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Impact of tumor localization on the outcomes of surgery for an intrahepatic cholangiocarcinoma

Abstract: HICC shows more frequent bile duct invasion and lymph node metastasis, requires more extensive surgery, and has a higher rate of non-curative resection than PICC. However, if curative resection is achieved, the survival outcomes are expected to be equivalent between HICC and PICC.

Cited by 25 publications

References 24 publications

Resection for intrahepatic cholangiocellular cancer: new advances

Resection for intrahepatic cholangiocellular cancer: new advances

Modifications of the AJCC 8th edition staging system for intrahepatic cholangiocarcinoma and proposal for a new staging system by incorporating serum tumor markers

Nomogram Based on Preoperative Clinical Characteristics to Predict the Risk of Lymph Node Metastasis in Hepatocellular Carcinoma

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