Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Surgery, Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Ann Surg Oncol. 2019 Aug;26(8):2549-2557. doi: 10.1245/s10434-019-07353-4. Epub 2019 Apr 24.
Recurrence of intrahepatic cholangiocarcinoma (ICC) after curative resection is common.
The aim of this study was to investigate the patterns, timing and risk factors of disease recurrence after curative-intent resection for ICC.
Patients undergoing curative resection for ICC were identified from a multi-institutional database. Data on clinicopathological and initial operation information, timing and first sites of recurrence, recurrence management, and long-term outcomes were analyzed.
A total of 920 patients were included. With a median follow-up of 38 months, 607 patients (66.0%) experienced ICC recurrence. In the cohort, 145 patients (23.9%) recurred at the surgical margin, 178 (29.3%) recurred within the liver away from the surgical margin, 90 (14.8%) recurred at extraheptatic sites, and 194 (32.0%) developed both intrahepatic and extrahepatic recurrence. Intrahepatic margin recurrence (median 6.0 m) and extrahepatic-only recurrence (median 8.0 m) tended to occur early, while intrahepatic recurrence at non-margin sites occurred later (median 14.0 m; p < 0.05). On multivariate analysis, surgical margin < 10 mm was associated with increased margin recurrence (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.11-2.60; p = 0.014), whereas female sex (HR 2.12, 95% CI 1.40-3.22; p < 0.001) and liver cirrhosis (HR 2.36, 95% CI 1.31-4.25; p = 0.004) were both associated with an increased risk of intrahepatic recurrence at other sites. Median survival after recurrence was better among patients who underwent repeat curative-intent surgery (48.7 months) versus other treatments (9.7 months) [p < 0.001].
Different recurrence patterns and timing of recurrence suggest biological heterogeneity of ICC tumor recurrence. Understanding timing and risk factors associated with different types of recurrence can hopefully inform discussions around adjuvant therapy, surveillance, and treatment of recurrent disease.
肝内胆管细胞癌（ICC）根治性切除术后复发较为常见。
本研究旨在探讨 ICC 根治性切除术后疾病复发的模式、时间和危险因素。
从多机构数据库中确定接受 ICC 根治性切除术的患者。分析了临床病理和初始手术信息、复发时间和首发部位、复发管理以及长期结果的数据。
共纳入 920 例患者。中位随访 38 个月时，607 例（66.0%）患者发生 ICC 复发。在该队列中，145 例（23.9%）患者在手术切缘复发，178 例（29.3%）患者在肝内非手术切缘部位复发，90 例（14.8%）患者在肝外部位复发，194 例（32.0%）患者同时出现肝内和肝外复发。肝内切缘复发（中位时间 6.0 个月）和肝外单发复发（中位时间 8.0 个月）倾向于早期发生，而肝内非切缘部位复发发生较晚（中位时间 14.0 个月；p<0.05）。多变量分析显示，手术切缘<10 mm 与切缘复发增加相关（风险比 [HR] 1.70，95%置信区间 [CI] 1.11-2.60；p=0.014），而女性（HR 2.12，95%CI 1.40-3.22；p<0.001）和肝硬化（HR 2.36，95%CI 1.31-4.25；p=0.004）均与肝内其他部位复发风险增加相关。与其他治疗方法（9.7 个月）相比，接受再次根治性手术治疗的患者（48.7 个月）复发后的中位生存时间更好（p<0.001）。
不同的复发模式和复发时间提示 ICC 肿瘤复发存在生物学异质性。了解与不同类型复发相关的时间和危险因素有望为辅助治疗、监测和复发性疾病的治疗提供信息。
