Evaluation of perioperative treatment strategy for intrahapetic cholangiocarcinoma on clinicopathological analysis

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Introduction: Intrahepatic cholangiocarcinoma (IHCA) generally has poor prognosis and surgical resection is the only curative treatment. However, 5-year survival rate is still around 30%. Cases in our department were analyzed to explore better treatment plans. Methods: Total of 33 patients with IHCA underwent surgical resection between June 2000 and October 2016 in our hospital. Five (15.9%) were of intraductal growth type (IG), 23 (71.8%) were of mass forming type (MF), 1 (3%) was of periductal infiltrating type (PI), and 4 (12.5%) were of MF+PI. We examined the cases excluding the 5 cases of IG considered to have relatively favorable prognosis. Results: Three patients underwent TACE preoperatively and 9 patients received adjuvant chemotherapy. Five-year survival rates of overall survival (OS) and disease-free survival (DFS) were 42.1% and 20.2%, respectively. Univariate analysis revealed that tumor differentiation (P = .049) and lymph node metastasis (P = .031) were significantly associated with OS, while bile duct invasion (P = .005) and lymph node metastasis (P = .001) were significantly associated with DFS. Tumor differentiation (P = .003) and lymph node metastasis (P = .031) remained independently associated with long-term survival by multivariate analysis. All 3 cases that were initially deemed unresectable were resectable by preoperative TACE, but did not improve survival. Conclusions: Prognostic factors were similar to previous reports. Preoperative TACE was superior in local control but did not improve survival. For future treatment strategy, preoperative TACE and systemic chemotherapy may be useful for acquiring curative resection and better survival.