Risk Factors and Outcomes of Early Relapse After Curative Resection of Intrahepatic Cholangiocarcinoma

Abstract

Early relapse after hepatectomy for intrahepatic cholangiocarcinoma (ICC) has a tremendous influence on the long-term survival outcomes of ICC patients. The purpose of our study was to investigate risk factors for early tumor relapse and confirm whether early relapse was correlated with ICC patients' long-term survival outcomes. Three hundred and twenty-two consecutive ICC patients undergoing partial hepatectomy at Liver Surgery Department of Zhongshan Hospital (Fudan University, Shanghai, China) between January 2005 and December 2011 were included in this retrospectively study. The definition of early relapse had been described as tumor relapse within 24 months after hepatectomy in ICC patients. We identified a total of 168 ICC patients with early relapse and 23 ICC patients with late relapse after hepatectomy. From the time of relapse, the long-term survival outcomes were worse among patients who had early vs. late relapse (median OS 16.5 vs. 44.7 months, respectively; P < 0.0001). The overall survival of the early relapse group was lower than that of the late relapse group (P < 0.0001). Multivariate Cox regression analysis indicated that multiple tumors (hazard ratio [HR], 1.951; 95% CI, 1.382–2.755; P < 0.001), lymphonodus metastasis (HR, 1.517; 95% CI, 1.061–2.168; P = 0.022), and higher serum CA19-9 levels (HR, 1.495; 95% CI, 1.095–2.039; P = 0.011) were independent risk factors of early relapse. Moreover, multiple tumors (HR, 1.641; 95% CI, 1.120–2.406; P = 0.011), lymphonodus metastasis (HR, 2.008; 95% CI, 1.367–2.949; P < 0.001), elevated NLR (HR, 1.921; 95% CI, 1.331–2.774; P < 0.001) and higher serum CA19-9 levels (HR, 1.990; 95% CI, 1.409–2.812; P < 0.001) were independent predictors of overall survival for ICC patients with early relapse. Collectively, our findings demonstrated that multiple tumors, lymphonodus metastasis, and higher serum CA19-9 levels were associated with the increased risks of early relapse and worse prognoses of ICC after curative-intent resection.

Integration of global metabolomics and lipidomics approaches reveals the molecular mechanisms and the potential biomarkers for postoperative recurrence in early-stage cholangiocarcinoma

“…Achieving long-term survival for CCA patients after treatment is the major challenge clinical because many patients develop recurrence after surgery, leading to the low survival rates [ 5 , 36 – 38 ]. Therefore, the prevention of cancer recurrence is the major clinical focus following surgery.…”

“…Therefore, the prevention of cancer recurrence is the major clinical focus following surgery. There is substantial evidence demonstrating the role of prognostic markers such as tumor size, tumor number, and metastasis status on CCA recurrence, and these have been suggested as prognostic markers for CCA recurrence [ 5 , 6 , 38 , 39 ]. In this study, we also found that T and TNM stages have the potential as prognostic markers for recurrence-free survival.…”

“…Surgery is the only curative treatment for CCA patients, and patient outcome is much improved when all residual tumor has been removed [ 4 ]. However, a high recurrence rate has been reported in CCA patients after surgery despite complete resection of the tumor, leading to an extremely poor prognosis [ 5 , 6 ]. There is a substantially lower survival rate in patients with recurrence compared to those with non-recurrence (median overall survival 35.7 vs. 19.3 months) [ 5 ].…”

“…However, a high recurrence rate has been reported in CCA patients after surgery despite complete resection of the tumor, leading to an extremely poor prognosis [ 5 , 6 ]. There is a substantially lower survival rate in patients with recurrence compared to those with non-recurrence (median overall survival 35.7 vs. 19.3 months) [ 5 ]. Recently, we reported the association of CSCs and recurrence with the overexpression of putative cancer stem-like cell (CSC) markers.…”

Immunotherapy in Advanced Biliary Tract Cancers

“…Surgery is the only potential curative treatment for BTCs, but approximately 70% of patients are diagnosed at advanced stages due to absence of specific symptoms [ 10 , 11 ]. Moreover, tumor relapse is frequent after curative-intent surgical resection [ 12 , 13 , 14 ]. Therapeutic options for non-resectable disease are scarce and treatment is only palliative [ 7 ].…”