Lymphovascular invasion and surgical complications predict clinical outcome in patients with perihilar and intrahepatic cholangiocarcinoma

Abstract

Background: Cholangiocarcinoma (CCC) is a relatively rare malignancy that is typically diagnosed at an advanced disease stage. Major liver resection with portal vein reconstruction has evolved as the mainstay of treatment for patients with perihilar (PHCC) and intrahepatic cholangiocarcinoma (IHCC). Despite recent advancements, the overall- (OS) and recurrence-free survival (RFS) in CCC remains lower than for most other solid tumors. Here we aimed to identify prognostic markers of clinical outcome in CCC-patients that underwent surgical resection in curative intent. Methods: Between 2010 and 2016, 162 patients with CCC (PHCC: n=91, IHCC; n=71) underwent surgery in curative intent at our institution. Preoperative characteristics, perioperative data and oncological follow-up were obtained from a prospectively managed institutional database. The associations of RFS and OS with clinico-pathological characteristics were assessed using univariate and multivariate survival analyses. Results: The median OS and RFS were 38 and 36 months for PHCC and 25 and 13 months for IHCC, respectively. Lymphovascular invasion (LVI) as well as surgical complications as assessed by the comprehensive complication index were independently associated with OS for the PHCC (LVI; Exp(B)=2.28, p=0.042; CCI; Exp(B)=1.04, p< 0.001) and IHCC cohorts (LVI, Exp(B)=5.08, p=0.028; CCI, Exp(B)=1.04, p=0.002), respectively. No other clinical variable including R0-status and Bismuth classification was associated with OS. Conclusions: Surgical resections for CCC are safe in experienced high-volume liver centers. Tumor and patient characteristics were not associated with clinical outcome. In patients with PHCC and IHCC, LVI and CCI are associated with OS, suggesting a similar tumor biology.