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Classification of Intrahepatic Cholangiocarcinoma into Perihilar Versus Peripheral Subtype. Annals of surgical oncology Wei, T., Lu, J., Xiao, X., Weiss, M., Popescu, I., Marques, H. P., Aldrighetti, L., Maithel, S. K., Pulitano, C., Bauer, T. W., Shen, F., Poultsides, G. A., Soubrane, O., Martel, G., Koerkamp, B. G., Itaru, E., Lv, Y., Zhang, X., Pawlik, T. M., International Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma Study Groups, U.S. Extrahepatic Biliary Malignancy Consortium,, 2023

Abstract

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) constitutes a group of heterogeneous malignancies within the liver. We sought to subtype ICC based on anatomical origin of tumors, as well aspropose modifications of the current classification system.METHODS: Patients undergoing curative-intent resection for ICC, hilar cholangiocarcinoma (CCA), or hepatocellular carcinoma (HCC) were identified from three international multi-institutional consortia of databases. Clinicopathological characteristics and survival outcomes were assessed.RESULTS: Among 1264 patients with ICC, 1066 (84.3%) were classified as ICC-peripheral subtype, whereas 198 (15.7%) were categorized as ICC-perihilar subtype. Compared with ICC-peripheral subtype, ICC-perihilar subtype was more often associated with aggressive tumor characteristics, including a higher incidence of nodal metastasis, macro- and microvascular invasion, perineural invasion, as well as worse overall survival (OS) (median: ICC-perihilar 19.8 vs. ICC-peripheral 37.1 months; p<0.001) and disease-free survival (DFS) (median: ICC-perihilar 12.8 vs. ICC-peripheral 15.2 months; p=0.019). ICC-perihilar subtype and hilar CCA had comparable OS (19.8 vs. 21.4 months; p=0.581) and DFS (12.8 vs. 16.8 months; p=0.140). ICC-peripheral subtype tumors were associated with more advanced tumor features, as well as worse survival outcomes versus HCC (OS, median: ICC-peripheral 37.1 vs. HCC 74.3 months; p<0.001; DFS, median: ICC-peripheral 15.2 vs. HCC 45.5 months; p<0.001).CONCLUSIONS: ICC should be classified as ICC-perihilar and ICC-peripheral subtype based on distinct clinicopathological features and survival outcomes. ICC-perihilar subtype behaved more like carcinoma of the bile duct (i.e., hilar CCA), whereas ICC-peripheral subtype had features and a prognosis more akin to a primary liver malignancy.

View details for DOI 10.1245/s10434-023-14502-3

View details for PubMedID 37930500