Zhang Xin, Huang Xi-Tai, Xie Jin-Zhao, Fu Ai-Qing, Chen Wei, Cai Jian-Peng, Liang Li-Jian, Yin Xiao-Yu
Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, People's Republic of China.
BMC Cancer. 2025 May 23;25(1):930. doi: 10.1186/s12885-025-13737-5.
Multifocal hepatic lesions represent a distinctive subgroup within intrahepatic cholangiocarcinoma(iCCA), the management of these patients remains controversial. This study aimed to compare the survival of intrahepatic cholangiocarcinoma (iCCA) with different numbers of hepatic lesions and select patients benefiting most from surgery in multifocal iCCA.
A cohort of 354 consecutive iCCA patients were included. Based on the number of hepatic lesions, patients were classified as follows: solitary tumors (type I), 2 or 3 hepatic lesions in the same-sided hepatic lobe (type II), and more than three hepatic lesions in the same-sided hepatic lobe (type III). Stabilized inverse probability treatment weighting (IPTW) was conducted for accurate prognosis comparisons. Furthermore, the long-term prognosis was compared between different American Joint Committee on Cancer.
Among all patients, multifocal iCCA presented significantly worse overall survival (OS) and recurrence-free survival (RFS) than solitary tumor (p < 0.001 and p < 0.001), 11.9% (n = 42), and 14.4% (n = 51) patients were classified into type II, and type III, respectively. After IPTW, type II exhibited similar while type III exhibited worse RFS and OS to type I cohort (solitary tumors) (p < 0.001and p < 0.001). Multivariable Cox analysis also identified type III tumors as an independent risk factor for OS (HR 1.95, 95% CI:1.33-2.87, p < 0.001). Among AJCC stage II (T2N0M0) patients, multifocal iCCA presented significantly worse OS than solitary tumors (vascular invasion) (p = 0.018), and type II exhibited similar while type III exhibited worse OS than solitary tumors (p = 0.500 and p = 0.040). Compared with stage III patients, type II exhibited better while type III exhibited similar OS (p < 0.001 and p = 0.300).
Multifocal iCCA presented a significantly worse prognosis, the number of hepatic lesions significantly influenced the prognosis of multifocal iCCA. Patients with type II tumors may derive comparable oncological benefits from surgery compared with solitary tumors, radical surgery still be strongly recommended as the preferred treatment.
多灶性肝内病变是肝内胆管癌（iCCA）中的一个独特亚组，这些患者的治疗仍存在争议。本研究旨在比较不同肝内病变数量的肝内胆管癌（iCCA）患者的生存率，并选择在多灶性iCCA中最能从手术中获益的患者。
纳入354例连续的iCCA患者队列。根据肝内病变数量，患者分为以下几类：孤立肿瘤（I型）、同一肝叶内2个或3个肝内病变（II型）以及同一肝叶内3个以上肝内病变（III型）。采用稳定的逆概率处理加权法（IPTW）进行准确的预后比较。此外，还比较了不同美国癌症联合委员会分期患者的长期预后。
在所有患者中，多灶性iCCA的总生存期（OS）和无复发生存期（RFS）明显低于孤立肿瘤（p<0.001和p<0.001），分别有11.9%（n=42）和14.4%（n=51）的患者被分类为II型和III型。IPTW后，II型患者的RFS和OS与I型队列（孤立肿瘤）相似，而III型患者的RFS和OS则较差（p<0.001和p<0.001）。多变量Cox分析也将III型肿瘤确定为OS的独立危险因素（HR 1.95，95%CI：1.33-2.87，p<0.001）。在美国癌症联合委员会II期（T2N0M0）患者中，多灶性iCCA的OS明显低于孤立肿瘤（血管侵犯）（p=0.018），II型患者的OS与孤立肿瘤相似，而III型患者的OS则较差（p=0.500和p=0.040）。与III期患者相比，II型患者的OS较好，而III型患者的OS相似（p<0.001和p=0.300）。
多灶性iCCA的预后明显较差，肝内病变数量显著影响多灶性iCCA的预后。与孤立肿瘤相比，II型肿瘤患者可能从手术中获得相当的肿瘤学益处，仍强烈建议将根治性手术作为首选治疗方法。
