Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Surgery, University of Verona, Verona, Italy.
Ann Surg Oncol. 2023 Mar;30(3):1340-1349. doi: 10.1245/s10434-022-12463-7. Epub 2022 Aug 27.
To investigate recurrence patterns after surgery for intrahepatic cholangiocarcinoma (ICC) relative to lymph node status, tumor extension, tumor burden score (TBS), and adjuvant chemotherapy.
Patients who underwent curative-intent resection for ICC from 1990 to 2020 were enrolled from a multi-institutional database. The hazard function was applied to plot the hazard rates over time, with further stratification by T and N AJCC 8th edition categories, TBS, and adjuvant chemotherapy.
A total of 1192 patients underwent curative-intent resection for ICC and 59.9% experienced recurrence. Overall, the peak of recurrence occurred at 6.6 months. Among patients with negative lymph nodes, the T4-category had a higher peak rate of recurrence (0.1199 at 10.2 months) compared with other T-categories, while high TBS had an earlier peak of recurrence (4.2 months) compared with lower TBS. Among patients with N1 disease, T2-T4 categories had multipeak patterns of recurrence with higher hazard rates during the first 3 years after surgery in comparison with T1-category, while patients with high TBS had an earlier (4.0 months) and higher hazard peak rate compared with lower TBS groups. The administration of adjuvant chemotherapy was associated with delayed hazard rates of recurrence for N1 (4 months) and NX (6 months) categories.
The novel application of the hazard function to assess hazard rates and timing patterns of recurrence following resection for ICC demonstrated that recurrence varied based on T- and N-categories, as well as TBS. Hazard function-based recurrence data may be helpful to tailor counseling, surveillance, and adjuvant therapy recommendations.
研究肝内胆管癌（ICC）手术后复发的模式与淋巴结状态、肿瘤扩展、肿瘤负担评分（TBS）和辅助化疗的关系。
从一个多机构数据库中招募了 1990 年至 2020 年接受根治性切除 ICC 的患者。应用危险函数绘制随时间变化的危险率，并根据第 8 版 AJCC 的 T 和 N 分类、TBS 和辅助化疗进一步分层。
共有 1192 例患者接受了根治性切除 ICC，59.9%的患者发生了复发。总体而言，复发的高峰期出现在 6.6 个月。在淋巴结阴性的患者中，T4 期的复发高峰率更高（10.2 个月时为 0.1199），而 TBS 较高的患者复发高峰期更早（4.2 个月）。在 N1 疾病的患者中，T2-T4 期的复发呈现多峰模式，与 T1 期相比，术后前 3 年的危险率更高，而 TBS 较高的患者复发的危险率更早（4.0 个月）和更高。辅助化疗的应用与 N1（4 个月）和 NX（6 个月）期的复发危险率延迟有关。
应用危险函数评估 ICC 切除术后复发的危险率和时间模式的新方法表明，复发的模式因 T 和 N 分类以及 TBS 而有所不同。基于危险函数的复发数据可能有助于定制咨询、监测和辅助治疗建议。
