Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2022; 14(5): 442-451
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.442
Prognostic factors for patients with mass-forming intrahepatic cholangiocarcinoma: A case series of 68 patients
Jian Feng, Bin Liang, Hang-Yu Zhang, Zhe Liu, Kai Jiang, Xiang-Qian Zhao
Jian Feng, Department of Hepatopancreatobiliary Surgery, Peking University Shougang Hospital, Beijing 100144, China
Jian Feng, Bin Liang, Hang-Yu Zhang, Zhe Liu, Kai Jiang, Xiang-Qian Zhao, Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Zhao XQ is the guarantor of integrity of the entire study, carried out the study design, defined the intellectual content, participated in the literature search, and reviewed the manuscript; Feng J and Liang B performed the research, wrote the first draft, and analyzed the data; Feng J and Liang B should be regarded as co-first authors; Zhang HY carried out the clinical studies and acquired the data; Liu Z and Jiang K carried out the clinical studies; all authors read and approved the final manuscript.
Institutional review board statement: The study was approved by the Medical Ethics Committee of the Chinese PLA General Hospital.
Conflict-of-interest statement: All authors have no competing interests to disclose.
Data sharing statement: Additional date are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang-Qian Zhao, MD, PhD, Deputy Director, Director, Professor, Surgeon, Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. zhaoxq8014@163.com
Received: October 11, 2021
Peer-review started: October 11, 2021
First decision: November 17, 2021
Revised: November 30, 2021
Accepted: April 20, 2022
Article in press: April 20, 2022
Published online: May 27, 2022
Processing time: 225 Days and 22 Hours
Abstract
BACKGROUND

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer in humans after hepatocellular carcinoma and a rare epithelial malignancy that results in a poor prognosis. According to the Liver Cancer Study Group of Japan classification, ICC can be divided into three types: Mass-forming (MF) type, periductal-infiltrating (PI) type, and intraductal-growth type. The MF type is the most common, accounting for 57.1-83.6% of ICCs. Nevertheless, little is known about the epidemiology and treatment of MF ICC.

AIM

To examine the prognostic factors for patients with MF ICC.

METHODS

We carried out a retrospective analysis of consecutive patients with MF ICC treated at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital between January 2008 and December 2018. According to the treatment received, the patients were divided into either a resection group or an exploration group.

RESULTS

The pooled 1-, 3-, and 5-year survival rates in the 68 patients with MF ICC were 66.5%, 36.3%, and 9.3%, respectively. Univariate analysis revealed that surgical resection (P < 0.001), nodal metastasis (P < 0.001), tumor location (P = 0.039), vascular invasion (P < 0.001), ascites (P < 0.001), and differentiation (P = 0.009) were significantly associated with the prognosis and survival of MF ICC. Multivariate analysis revealed that ascites (hazard ratio [HR] = 5.6, 95% confidence interval [CI]: 1.6-18.9, P = 0.006) and vascular invasion (HR = 2.5, 95%CI: 1.0-6.1, P = 0.045) were independent risk factors for MF ICC. The pooled 1-, 3-, and 5-year survival rates in the 19 patients of the exploration group were 5.3%, 5.3%, and 0, respectively. Among the 49 patients who underwent surgical resection, the pooled 1-, 3-, and 5-year survival rates were 93.5%, 49.7%, and 14.4%, respectively. Univariate and multivariate analyses revealed that vascular invasion (HR = 3.1, 95%CI: 1.2-8.5, P = 0.024) and nodal metastasis (HR = 3.2, 95%CI: 1.4-7.6, P = 0.008) were independent prognostic risk factors for surgical resection patients.

CONCLUSION

The prognosis of MF ICC patients is dismal, especially those with ascites or vascular invasion. Surgical resection is a key factor in improving overall survival in patients with MF ICC, and vascular invasion and lymph node metastasis affect the efficacy of surgical resection.

Keywords: Intrahepatic cholangiocarcinoma; Mass-forming; Treatment; Prognosis

Core Tip: This is a single-center, large-scale retrospective study on mass-forming intrahepatic cholangiocarcinoma (MF ICC) to examine the prognostic factors for MF ICC and improve the outcomes. The study found the patients with MF ICC with ascites and vascular invasion have a poor prognosis. Surgical resection is a key factor in improving overall survival in patients with MF ICC, and patients with vascular invasion and lymph node metastasis have poor surgical results.