Macroscopic types of intrahepatic cholangiocarcinoma: clinicopathologic features and surgical outcomes

The prognosis of patients with intrahepatic cholangiocarcinoma is different for the different macroscopic types of this tumor. This study correlated clinicopathologic features and outcome after surgery with macroscopic types of intrahepatic cholangiocarcinoma to determine prognostic predictors.

Resected intrahepatic cholangiocarcinomas were classified into the following growth types: mass-forming (n = 10), periductal-infiltrating (n = 11), mass-forming plus periductal-infiltrating (n = 14), and intraductal (n = 2). Intraductal tumors were not considered further. The prognostic significance of clinicopathologic features was determined by univariate and multivariate analyses.

Perineural invasion (P = 0.00051), lymphatic invasion (P = 0.0088), and positive resection margin (P = 0.028) were less frequent in patients with mass-forming tumors than with mass-forming plus periductal-infiltrating tumors. Patients with mass-forming plus periductal-infiltrating tumors had shorter survival than those with mass-forming tumors (P = 0.0072). By univariate analysis, an elevated serum carcinoembryonic antigen concentration, lymphatic invasion, lymph node metastasis, intrahepatic metastasis, and positive resection margin predicted shorter survival after surgery. An elevated serum carcinoembryonic antigen concentration, lymphatic invasion, and positive resection margin were independent prognostic factors on multivariate analysis. The macroscopic type did not correlate independently with prognosis.

Extended hepatic resection should be performed in patients with intrahepatic cholangiocarcinoma to obtain a tumor-free margin of resection.