Recurrent Intrahepatic Cholangiocarcinoma: A 10-Point Score to Predict Post-Recurrence Survival and Guide Treatment of Recurrence (original) (raw)

Abstract

Introduction

Although up to 50–70% of patients with intrahepatic cholangiocarcinoma (ICC) recur following resection, data to predict post-recurrence survival (PRS) and guide treatment of recurrence are limited.

Methods

Patients who underwent resection of ICC between 2000 and 2020 were identified from an international, multi-institutional database. Data on primary disease as well as laboratory and radiologic data on recurrent disease were collected. Factors associated with PRS were examined and a novel scoring system to predict PRS (PRS score) was developed and internally validated.

Results

Among 986 individuals who underwent resection for ICC, 588 (59.6%) patients developed recurrence at a median follow up of 20.3 months. Among patients who experienced a recurrence, 97 (16.5%) underwent re-resection/ablation for recurrent ICC; 88 (15.0%) and 403 (68.5%) patients received intra-arterial treatment or systemic chemotherapy/supportive therapy, respectively. Patient American Society of Anesthesiologists (ASA) class > 2 (1 point), primary tumor N1/Nx status (1 point), primary R1 resection margin (1 point), primary tumor G3/G4 grade (1 point), carbohydrate antigen (CA) 19-9 > 37 UI/mL (2 points) at recurrence and carcinoembryonic antigen (CEA) > 5 ng/mL (2 points) at recurrence, as well as recurrent bilateral disease (1 point) and early recurrence (1 point) were included in the PRS score. The PRS score successfully stratified patients relative to PRS and demonstrated strong discriminatory ability (C-index 0.70, 95% confidence interval 0.68–0.72). While a PRS score of 0–3 was associated with a 3-year PRS of 62.5% following resection/ablation for recurrent ICC, a PRS score > 3 was associated with a low 3-year PRS of 35.5% (p = 0.03).

Conclusions

The PRS score demonstrated strong discriminatory ability to predict PRS among patients who had developed recurrence following initial resection of ICC. The PRS score may be a useful tool to guide treatment among patients with recurrent ICC.

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Funding

No sources of funding were used to assist in the preparation of this work.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
    Diamantis I. Tsilimigras MD, Yutaka Endo MD, PhD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA
  2. Department of Surgery, University of Verona, Verona, Italy
    Alfredo Guglielmi MD
  3. Department of Surgery, Ospedale San Raffaele, Milan, Italy
    Luca Aldrighetti MD
  4. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
    Matthew Weiss MD
  5. Department of Surgery, University of Virginia, Charlottesville, VA, USA
    Todd W. Bauer MD
  6. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
    Irinel Popescu MD
  7. Department of Surgery, Stanford University, Stanford, CA, USA
    George A. Poultsides MD
  8. Department of Surgery, Emory University, Atlanta, GA, USA
    Shishir K. Maithel MD
  9. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
    Hugo P. Marques MD
  10. Department of Surgery, University of Ottawa, Ottawa, ON, Canada
    Guillaume Martel MD
  11. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
    Carlo Pulitano MD
  12. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
    Feng Shen MD
  13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France
    François Cauchy MD
  14. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
    Bas Groot Koerkamp MD
  15. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
    Itaru Endo MD, PhD

Authors

  1. Diamantis I. Tsilimigras MD
  2. Yutaka Endo MD, PhD
  3. Alfredo Guglielmi MD
  4. Luca Aldrighetti MD
  5. Matthew Weiss MD
  6. Todd W. Bauer MD
  7. Irinel Popescu MD
  8. George A. Poultsides MD
  9. Shishir K. Maithel MD
  10. Hugo P. Marques MD
  11. Guillaume Martel MD
  12. Carlo Pulitano MD
  13. Feng Shen MD
  14. François Cauchy MD
  15. Bas Groot Koerkamp MD
  16. Itaru Endo MD, PhD
  17. Timothy M. Pawlik MD, PhD, MPH, MTS, MBA

Corresponding author

Correspondence toTimothy M. Pawlik MD, PhD, MPH, MTS, MBA.

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This work was accepted as an E-Poster at the Society of Surgical Oncology (SSO) 2024 Annual Meeting, Atlanta, GA, USA.

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10434_2024_15210_MOESM1_ESM.pdf

Online Resource Fig. 1 Violin plot of recurrent disease treatment allocation relative to PRS score. The hollow dot represents the median value, the gray box represents the IQR, while gray lines indicate the minimum and maximum values. The width represents the frequency of observations. PRS Post-recurrence score, IQR Interquartile range (PDF 68 KB)

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Tsilimigras, D.I., Endo, Y., Guglielmi, A. et al. Recurrent Intrahepatic Cholangiocarcinoma: A 10-Point Score to Predict Post-Recurrence Survival and Guide Treatment of Recurrence.Ann Surg Oncol 31, 4427–4435 (2024). https://doi.org/10.1245/s10434-024-15210-2

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