Treatment outcomes and prognostic factors of intrahepatic cholangiocarcinoma

Dhanasekaran,Renumathy; Hemming,Alan  W.; Zendejas,Ivan; George,Thomas; Nelson,David  R.; Soldevila-Pico,Consuelo; Firpi,Roberto J.; Morelli,Giuseppe; Clark,Virginia; Cabrera,Roniel

doi:10.3892/or.2013.2290

Treatment outcomes and prognostic factors of intrahepatic cholangiocarcinoma

Authors:
- Renumathy Dhanasekaran
- Alan W. Hemming
- Ivan Zendejas
- Thomas George
- David R. Nelson
- Consuelo Soldevila-Pico
- Roberto J. Firpi
- Giuseppe Morelli
- Virginia Clark
- Roniel Cabrera
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Affiliations: Department of Medicine, University of Florida, Gainesville, FL, USA, Department of Surgery, University of California, San Diego, CA, USA, Department of Surgery, university of Florida, Gainesville, Fl, USA, Division of Hematology and Oncology, university of Florida, Gainesville, Fl, USA, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Fl, USA
Published online on: February 18, 2013 https://doi.org/10.3892/or.2013.2290
Pages: 1259-1267
Copyright: © Dhanasekaran et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

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Abstract

The aim of the present study was to determine the treatment outcome and prognostic factors for survival in patients with peripheral intrahepatic cholangiocarcinoma (ICC). A retrospective chart review was performed for patients diagnosed with ICC between 2000 and 2009 at a single institution. We identified a total of 105 patients with ICC. Among them, 63.8% were older than 60 years of age, 50.5% were male and 88.6% were Caucasian. By preoperative imaging approximately half of the patients (50.5%) were surgical candidates and underwent resection. The other half of the patients (49.5%) were unresectable. The unresectable group received chemoradiotherapy (53%) and transarterial chemoembolization (7.7%) as palliative treatments while 23.0% of the patients (12/52) received best supportive care alone. The median survival rates were 16.1 months (13.1‑19.2) for the entire cohort, 27.6 months (17.7-37.6) for curative resection, 12.9 months (6.5-19.2) for palliative chemoradiotherapy and 4.9 months (0.4-9.6) for best supportive care (p<0.001). Independent predictors on multivariate analysis were advanced stage at diagnosis and treatment received. In those patients who underwent resection, advanced AJCC stage and presence of microvascular invasion were also independent predictors of poor survival. We concluded that surgery offers the most beneficial curative option and outcome, emphasizing the importance of resectability as a major prognostic factor. The present study also revealed that use of chemoradiotherapy in the adjuvant setting failed to improve survival but its palliative use in those patients with unresectable ICC offered a modest survival advantage over best supportive care. The overriding factors influencing outcome were stage and the presence of microvascular invasion on pathology.

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