Oncological Outcome after Surgical Resection for Intrahepatic Cholangiocarcinoma Can Be Predicted Based on Radiological Features

Abstract

Introduction: Preoperative patient selection is crucial in intrahepatic cholangiocarcinoma (iCCA) as high rates of recurrence and dismal oncological outcome is observerd after surgical resection.Therefore, we aimed to identify characteristics with prognostic value focusing on preoperative radiological features. Method: A cohort of 139 patients who underwent hepatectomy for iCCA between 2010 and 2020 at University Hospital, RWTH Aachen were eligible for this study. Kaplan–Meier and Cox regressions were used for survival analysis and associations of overall survival (OS) and recurrence-free survival (RFS) with clinical/radiological characteristics, respectively. Results: Based on radiological features patients were stratified into three groups: single nodule ≤ 3 cm, single nodule > 3 cm, and ≥ 2 nodules. Oncological analysis revealed a mean OS of 142 months in individuals with a single nodule ≤ 3 cm, median OS of 28 months with a single nodule > 3 cm, and 19 months with ≥ 2 nodules, respectively. Multivariable analyses based on preoperative characteristics showed the radiological stratification to be independently associated with OS (HR (hazard ratio) = 4.25 (1 nodule, > 3 cm), HR = 5.97 (≥ 2 nodules), p = 0.011), RFS (HR = 4.18 (1 nodule, > 3 cm), and HR = 11.07 (≥2 nodules), p = 0.001). Conclusions: Patients with single iCCA ≤ 3 cm show compelling OS and RFS. Basic radiological features (e.g., nodule size, number) are prognostic for patients undergoing surgery and useful in preoperative patient selection.