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Long-Term Recurrence-Free and Overall Survival Differ Based on Common, Proliferative, and Inflammatory Subtypes After Resection of Intrahepatic Cholangiocarcinoma. Annals of surgical oncology Alaimo, L., Moazzam, Z., Endo, Y., Lima, H. A., Ruzzenente, A., Guglielmi, A., Aldrighetti, L., Weiss, M., Bauer, T. W., Alexandrescu, S., Poultsides, G. A., Maithel, S. K., Marques, H. P., Martel, G., Pulitano, C., Shen, F., Cauchy, F., Koerkamp, B. G., Endo, I., Pawlik, T. M. 2022

Abstract

INTRODUCTION: While generally associated with poor prognosis, intrahepatic cholangiocarcinoma (ICC) can have a heterogeneous presentation and natural history. We sought to identify specific ICC subtypes that may be associated with varied long-term outcomes and patterns of recurrence after liver resection.METHODS: Patients who underwent curative-intent resection for ICC from 2000 to 2020 were identified from a multi-institutional database. Hierarchical cluster analysis characterized three ICC subtypes based on morphology (i.e., tumor burden score [TBS]) and biology (i.e., preoperative neutrophil-to-lymphocyte ratio [NLR] and CA19-9 levels).RESULTS: Among 598 patients, the cluster analysis identified three ICC subtypes: Common (n=300, 50.2%) (median, TBS: 4.5; NLR: 2.4; CA19-9: 38.0U/mL); Proliferative (n=246, 41.1%) (median, TBS: 8.8; NLR: 2.9; CA19-9: 71.2U/mL); Inflammatory (n=52, 8.7%) (median, TBS: 5.4; NLR: 12.6; CA19-9: 26.7U/mL). Median overall survival (OS) (Common: 72.0months; Proliferative: 31.4months; Inflammatory: 22.9months) and recurrence-free survival (RFS) (Common: 21.5months; Proliferative: 11.9 months; Inflammatory: 9.0months) varied considerablyamong the different ICCsubtypes (all p<0.001). Even though patients with Inflammatory ICC had more favorable T-(T1/T2, Common: 84.4%; Proliferative: 80.6%; Inflammatory: 86.5%) and N-(N0, Common: 14.0%; Proliferative: 20.7%; Inflammatory: 26.9%) disease, theInflammatory subtype was associated with a higher incidence of intra- and extrahepatic recurrence (Common: 15.8%; Proliferative: 24.2%; Inflammatory: 28.6%) (all p=0.01).CONCLUSIONS: Cluster analysis identified three distinct subtypes of ICC based on TBS, NLR, and CA19-9. ICC subtype was associated with RFS and OS and predicted worse outcomes among patients. Despite more favorable T- and N-disease, the Inflammatory ICC subtype was associated with worse outcomes ICC subtype should be considered in the prognostic stratification of patients.

View details for DOI 10.1245/s10434-022-12795-4

View details for PubMedID 36383331