Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches

Diamantis I Tsilimigras ¹, Kota Sahara ^1,2, Lu Wu ^1,3

¹James Comprehensive Cancer Center, Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus.
²Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
³Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
⁴Department of Surgery, University of Verona, Verona, Italy.
⁵Department of Surgery, Ospedale San Raffaele, Milano, Italy.
⁶Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
⁷Department of Surgery, University of Virginia, Charlottesville.
⁸Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
⁹Department of Surgery, Stanford University, Stanford, California.
¹⁰Department of Surgery, Emory University, Atlanta, Georgia.
¹¹Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
¹²Department of Surgery, University of Ottawa, Ottawa, Canada.
¹³Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
¹⁴Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France.
¹⁵Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
¹⁶Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
¹⁷Institute of Advanced Surgical Technology and Engineering, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
¹⁸Deputy Editor, JAMA Surgery .

⁰James Comprehensive Cancer Center, Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus.

Jama Surgery +

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July 9, 2020

View abstract on PubMed

Summary

This study developed an online calculator to predict very early recurrence (VER) in intrahepatic cholangiocarcinoma (ICC) patients after surgery. The tool aids clinicians in patient selection for neoadjuvant therapy and informs postoperative surveillance strategies.

Area Of Science

Hepatobiliary surgery
Surgical oncology
Gastroenterology

Background

Intrahepatic cholangiocarcinoma (ICC) prognosis is poor due to high recurrence rates post-surgery.
Surgery offers the best cure potential for resectable ICC, but predicting recurrence remains challenging.

Purpose Of The Study

To develop predictive models for very early recurrence (VER) within 6 months after ICC resection.
To create and validate an online calculator for predicting VER in pre- and postoperative settings.

Main Methods

Logistic regression models were built using pre- and postoperative variables from an international multi-institutional database of 880 ICC patients.
Models were validated internally and externally, and an online calculator was developed.

Main Results

22.3% of patients experienced VER, with significantly lower 5-year survival (8.9% vs. 49.8%).
Both preoperative and postoperative models effectively stratified patients into low, intermediate, and high risk for VER.
The online calculator demonstrated good predictive accuracy in validation datasets (C-index: 0.672-0.728).

Conclusions

An online calculator can accurately predict VER risk in ICC patients post-resection.
This tool can assist in preoperative treatment decisions and postoperative surveillance planning.
The calculator's validated performance supports its clinical utility for managing ICC.