Clinical and Molecular Genetic Prognosis Factors after Surgical Treatment of Intrahepatic Cholangiocarcinoma

Abstract

The aim: To study the clinical-morphological and molecular-genetic factors affecting the long-term results after surgical treatment of intrahepatic cholangiocarcinoma(ICC). Materials and Methods: Results of surgical treatment of 67 patients with ICC analyzed. The material obtained after liver resection was subjected to morphological and molecular genetic studies. The effect of tumor size, number of tumors, degree of differentiation, state of the resection margin, presence of capsule invasion, vascular invasion, the presence of metastases in regional lymph nodes on long-term results were assessed. Frequency of various mutations in ICC and their effect on long-term outcomes were assessed. In the long term, 94% of the operated patients were followed up. Results: Median overall survival was 38 months. 1-year cumulative survival rate was 71.5%, 3-year - 51.5%, 5-year - 27%. The clinical and morphological factors influencing the prognosis were the radicality of the operation (criterion R) and presence of metastases in the regional lymph nodes (log-rank, p <0.05). Frequency of gene mutations:KRAS - 27% (n = 10), IDH1/2 - 24%(n = 9), NRAS - 11% (n = 4), PIK3CA - 8%(n = 3), MET - 11%(n = 4), BRAF600 - 8%(n = 4), EGRF-4%(n = 1), ERBB2- 6% (n=2). Conclusion: The main strategy for surgical treatment of intrahepatic cholangiocarcinoma should be aggressive surgical tactics aimed at achieving R0 resection and mandatory lymphadenectomy. Mutations in a favorable prognosis are mutations in the IDH1/2 genes, mutations in the MET, PIK3CA genes are factors of an unfavorable prognosis.