Investigation of a Tumor Location-Specific Therapeutic Strategy for Intrahepatic Cholangiocarcinoma.

Hisashi Kosaka,Morihiko Ishizaki,Mitsugu Sekimoto,Hideyuki Matsushima,Kosuke Matsui,Masaki Kaibori

doi:10.31557/apjcp.2021.22.5.1485

Abstract

Objective:An optimal therapeutic strategy for intrahepatic cholangiocarcinoma (ICC) has not yet been determined. Herein we focused on intrahepatic tumor location and retrospectively analyzed tumor characteristics depending on location to elucidate a location-specific therapeutic strategy for ICC. Methods:Sixty-five ICC patients were divided into three groups based on the distance between the innermost portion of the tumor and portal vein branches observed on preoperative imaging: peripheral, intermediate and central ICC. Results:Median disease-specific survival (DSS) of the peripheral ICC was not reached, whereas median DSS was 32.9 months in intermediate ICC and 25.2 months in central ICC (p <0.05). Vascular invasion was observed in all groups (56-92%). Bile duct invasion to the first branch of the hepatic duct was more commonly observed in central ICC (43%) compared with the peripheral and intermediate ICC (0-8%). Lymph node metastasis was not observed in peripheral ICC, whereas it was frequently observed in intermediate and central ICC (39-44%). A Cox regression analysis revealed sufficient RDI (≥58.3%) of adjuvant chemotherapy (AC) significantly increased the length of DSS (HR: 0.205). Based on these data, we have proposed a location-specific therapeutic strategy as follows: peripheral ICC requires anatomical resection without lymphadenectomy; intermediate ICC requires anatomical resection with lymphadenectomy and sufficient doses of AC; and central ICC requires anatomical resection with extrahepatic bile duct resection, caudate lobectomy, lymphadenectomy, and sufficient doses of AC. Conclusion:We propose an intrahepatic tumor location-specific therapeutic strategy for ICC. This information could contribute to the appropriate therapeutic management of patients with ICC.

Highlights

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer arising in the liver, making up about 10% of all cholangiocarcinoma cases (Buettner et al, 2017; Shaib et al, 2004)
We focused on intrahepatic tumor location and retrospectively analyzed tumor characteristics depending on location to elucidate a location-specific therapeutic strategy for intrahepatic cholangiocarcinoma (ICC)
We focused on intrahepatic tumor location and retrospectively analyzed tumor characteristics and clinical outcomes depending on tumor location to evaluate a tumor location-specific therapeutic strategy for ICC using preoperative imaging findings

Summary

Introduction

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer arising in the liver, making up about 10% of all cholangiocarcinoma cases (Buettner et al, 2017; Shaib et al, 2004). 30-47% of ICC patients who undergo lymphadenectomy have LN metastasis, it is challenging to diagnose LN metastasis preoperatively, and the necessity of lymphadenectomy is not yet well defined (Zhang et al, 2020; Bektas et al, 2015; Mavros et al, 2014; Li et al, 2013). Rates of curative resection for patients with ICC have been reported to be 65-87% (Marubashi et al, 2014; Bektas et al, 2015; Reames et al, 2017). Appropriate preoperative surgical planning is indispensable for achieving curative resection; longitudinal intraductal tumor extension is difficult to diagnose preoperatively (Yao et al, 2018; Ji et al, 2019)

Methods

Results

Conclusion