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Updated: May 23, 2026
The Influence of Liver Resection on Intrahepatic Tumor Growth
Published on: April 9, 2016
Association between primary tumor resection and survival in metastatic intrahepatic cholangiocarcinoma: a
Xiao Yang1,2, Ruonan Xu3, Zhe Xu3
1Senior Department of Pediatrics, The Seventh Medical Centre of PLA General Hospital, Beijing, China.
Background:
Intrahepatic cholangiocarcinoma (ICC) with distant metastasis [M1, the American Joint Committee on Cancer (AJCC) Tumor, Node, Metastasis (TNM) stage] is universally classified as terminal, with systemic chemotherapy offering limited survival benefits. While guidelines discourage surgical intervention for M1 ICC due to perceived futility, emerging evidence suggests potential survival advantages in select populations. This study evaluates the prognostic impact of primary tumor surgery in patients with M1 ICC.
Methods:
Using the Surveillance, Epidemiology, and End Results (SEER) database (2004-2020), we identified 256 patients with pathologically confirmed ICC and distant metastasis recommended for primary tumor resection. Propensity score matching (PSM, 1:1 ratio) were applied to adjust for confounders, including age, sex, tumor grade, TNM stage, and chemotherapy status. Cox proportional hazards models and Kaplan-Meier survival analysis were utilized to assess overall survival (OS) and cancer-specific survival (CSS).
Results:
Of the 256 patients included, 169 (66%) received surgery. Surgical treatment was related to better OS. After PSM, 68 pairs of patients demonstrated balanced baseline characteristics. Surgical treatment was significantly associated with improved OS [median 8 vs. 4 months; hazard ratio (HR) =0.591, 95% confidence interval (CI): 0.402-0.869; P=0.002] and CSS (median 11 vs. 7 months; HR =0.638, 95% CI: 0.412-0.988; P=0.03). Multivariable analysis confirmed independent prognostic roles for surgery (OS: HR =0.612, P=0.004; CSS: HR =0.645, P=0.02) and chemotherapy (OS: HR =0.573, P<0.001; CSS: HR =0.598, P=0.002).
Conclusions:
Primary site surgery was associated with improved survival in selected M1 ICC patients, supporting its role in carefully selected cases. However, this observational study cannot exclude selection bias, underscoring the need for cautious interpretation and multidisciplinary optimization of patient selection.
