Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Prognostic Factors for Intrahepatic Cholangiocarcinoma Treated with Surgical Resection

근치적 절제수술로 치료한 간내 담관암의 예후인자

  • Kim, Young-Min (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University, School of Medicine) ;
  • Kim, Yong-Hoon (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University, School of Medicine) ;
  • Lim, Tae-Jin (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University, School of Medicine) ;
  • Kang, Koo-Jeong (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Keimyung University, School of Medicine)
  • 김영민 (계명대학교 의과대학 외과학교실) ;
  • 김용훈 (계명대학교 의과대학 외과학교실) ;
  • 임태진 (계명대학교 의과대학 외과학교실) ;
  • 강구정 (계명대학교 의과대학 외과학교실)
  • Published : 2010.09.30
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Abstract

Purpose: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy, but outcome studies are uncommon. The purpose of this study was to determine outcomes and prognostic factors after surgical resection. Methods: We reviewed and analyzed retrospectively fifty four patients who were diagnosed as having intrahepatic cholangiocarcinoma and whose tumor was resected surgically between 2001 and 2009. Our analysis focused on survival and on significant prognostic factors affecting survival after surgical resection. Results: Forty-one subjects (75.9%) were male and twelve (24.1%) were female. The average age was 59.4 years old. For predisposing factors, infestation of clonorchis sinensis plus hepatitis B antigen positivity were 11.1% respectively. Among tumor markers, CA 19-9 was elevated in 50.9% and CEA in 30%. Eighty percent were treated by major hepatectomy. Overall 3 & 5 year-survival rates were 41.8% and 36.2%, and 3 and 5 year disease free survival rates were 37.5% and 28.6%, respectively. By univariate analysis, significant prognostic factors affecting cumulative survival were tumor size, vascular invasion, tumor differentiation, serosal invasion, metastasis to the regional lymph nodes and tumor markers CEA and CA 19-9. By multivariate analysis, only differentiation and metastasis to the lymph nodes were significant. Conclusion: The prognosis of intrahepatic cholangiocarcinoma is poor but has been improved by curative surgical resection. Tumor factors, tumor differentiation and lymph node metastasis were elucidated as the most significant prognostic factors, and radical surgical resection is the only way to get a better outcome from IHC that has a notoriously poor prognosis.

Keywords

References

  1. Tompkins RK, Saunders K, Roslyn JJ, Longmire WP Jr. Changing patterns in diagnosis and management of bile duct cancer. Ann Surg 1990;211:614-620.
  2. Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 1996;224:463-473. https://doi.org/10.1097/00000658-199610000-00005
  3. Endo I, Gonen M, Yopp AC, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg 2008;248:84-96. https://doi.org/10.1097/SLA.0b013e318176c4d3
  4. Lee HS, You JH, Nah YW. Peripheral cholangicoarcinoma. J Korean Surg Soc 1997;52:363-370.
  5. Yeh CN, Jan YY, Yeh TS, Hwang TL, Chen MF. Hepatic resection of the intraductal papillary type of peripheral cholangiocarcinoma. Ann Surg Oncol 2004;11:606-611. https://doi.org/10.1245/ASO.2004.04.028
  6. Blechacz BR, Sanchez W, Gores GJ. A conceptual proposal for staging ductal cholangiocarcinoma. Curr Opin Gastroenterol 2009;25:238-239. https://doi.org/10.1097/MOG.0b013e3283292383
  7. Shin HR, Oh JK, Lim MK, et al. Descriptive epidemiology of cholangiocarcinoma and clonorchiasis in Korea. J Korean Med Sci 2010;25:1011-1016. https://doi.org/10.3346/jkms.2010.25.7.1011
  8. Song GW, Lee SG, Lee YJ, et al. Analysis of survival and factors affecting the survival after surgical resection of peripheral cholangiocarcinoma: 318 cases in single institute. Korean J Hepatol 2007;13:208-221.
  9. Ercolani G, Vetrone G, Grazi GL, et al. Intrahepatic cholangiocarcinoma: primary liver resection and aggressive multimodal treatment of recurrence significantly prolong survival. Ann Surg 2010;252:107-114. https://doi.org/10.1097/SLA.0b013e3181e462e6
  10. Eun JR, Jang BI, Lee JY, et al. Clinical characteristics of intrahepatic cholangiocarcinoma and prognostic factors in patients who received non-surgical treatment. Korean J Gastroenterol 2009;54:227-234. https://doi.org/10.4166/kjg.2009.54.4.227
  11. Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T. Criteria for safe hepatic resection. Am J Surg 1995;169:589-594. https://doi.org/10.1016/S0002-9610(99)80227-X
  12. Lee SY, Kang KJ, Kim YH, et al. Outcomes of hepatic resection using intermittent hepatic vascular inflow occlusion with low central venous pressure. Korean J Hepatobiliary Pancreat Surg 2004;8:98-104.
  13. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. Lancet 2005;366:1303-1314. https://doi.org/10.1016/S0140-6736(05)67530-7
  14. Nathan H, Aloia TA, Vauthey JN, et al. A proposed staging system for intrahepatic cholangiocarcinoma. Ann Surg Oncol 2009;16:14-22. https://doi.org/10.1245/s10434-008-0180-z
  15. Edge SB, Byrd DR, Compton CC, et al. Intrahepatic bile ducts. AJCC cancer staging manual (7th ed) 2010:201-205.
  16. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471-1474. https://doi.org/10.1245/s10434-010-0985-4
  17. Lee JH, Chung GE, Yu SJ, et al. Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma. J Clin Gastroenterol 2010. [Epub ahaed of print].
  18. Zhou H, Wang H, Zhou D, et al. Hepatitis B virus-associated intrahepatic cholangiocarcinoma and hepatocellular carcinoma may hold common disease process for carcinogenesis. Eur J Cancer 2010;46:1056-1061. https://doi.org/10.1016/j.ejca.2010.02.005
  19. Kubo S, Kinoshita H, Hirohashi K, Hamba H. Hepatolithiasis associated with cholangiocarcinoma. World J Surg 1995;19: 637-641. https://doi.org/10.1007/BF00294744
  20. Suh KS, Roh HR, Koh YT, Lee KU, Park YH, Kim SW. Clinicopathologic features of the intraductal growth type of peripheral cholangiocarcinoma. Hepatology 2000;31:12-17. https://doi.org/10.1002/hep.510310104
  21. Lang H, Sotiropoulos GC, Sgourakis G, et al. Operations for intrahepatic cholangiocarcinoma: single-institution experience of 158 patients. J Am Coll Surg 2009;208:218-228. https://doi.org/10.1016/j.jamcollsurg.2008.10.017
  22. Cho SY, Park SJ, Kim SH, et al. Survival analysis of intrahepatic cholangiocarcinoma after resection. Ann Surg Oncol 2010;17:1823-1830. https://doi.org/10.1245/s10434-010-0938-y
  23. Guglielmi A, Ruzzenente A, Campagnaro T, et al. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg 2009;33:1247-1254. https://doi.org/10.1007/s00268-009-9970-0