Abstract
The purpose of our study was to evaluate the effect of surgery on the survival and prognosis of patients with multifocal intrahepatic cholangiocarcinoma (ICCA). Patients with multifocal ICCA were selected from the SEER (Surveillance, Epidemiology, and End Results) database between 2010 and 2016. Kaplan–Meier analyses and log-rank tests were used to evaluate the difference in survival between the surgery group and the non-surgery group. We applied the Cox proportional hazards regression model to identify prognostic factors of overall survival (OS) and cancer-specific survival (CSS). In total, 580 patients were enrolled in our study, including 151 patients who underwent surgery and 429 patients who did not. The median survival time of surgical patients was longer than non-surgical patients (OS: 25 months vs. 8 months, p < 0.001; CSS: 40 months vs. 25 months, p < 0.001). Similarly, the 5-year survival rate in the surgery group was significantly higher than those in the non-surgery group (5-year OS rate: 12.91% vs. 0%; p < 0.001; 5-year CSS rate:26.91% vs. 0%; p < 0.001). Multivariate Cox analysis showed that the OS (HR:0.299, 95% CI: 0.229–0.390, p < 0.001) and CSS (HR:0.305, 95% CI:0.222–0.419, p < 0.001) of patients undergoing surgical resection were significantly improved. Meanwhile, after propensity score matching (PSM) of the original data, we come to the same conclusion.
Highlights
The purpose of our study was to evaluate the effect of surgery on the survival and prognosis of patients with multifocal intrahepatic cholangiocarcinoma (ICCA)
The results revealed that the overall survival (OS) of Age < 65 years old was improved compared to Age ≥ 65 years old; the OS of women was significantly longer than men; the prognosis of patients with tumor Grade I–II was better than grade III– IV; and patients without lymph node metastasis were more likely to benefit from surgery (Supplementary Table S2)
Because the surgical operation of multifocal ICCA means enlarging the volume of hepatectomy, which may lead to more postoperative liver failure and increase the risk of postoperative adverse events or perioperative d eath[15]
Summary
The purpose of our study was to evaluate the effect of surgery on the survival and prognosis of patients with multifocal intrahepatic cholangiocarcinoma (ICCA). Cholangiocarcinoma (CCA) is a heterogeneous biliary carcinoma (BTC) originating from intrahepatic and extrahepatic bile duct epithelial c ells[1]. Intrahepatic cholangiocarcinoma usually has no obvious symptoms and signs (such as jaundice); patients with ICCA may develop locally advanced or metastatic diseases, missing the opportunity for surgical r esection[8]. In the study of Lamarca et al, patients with multiple lesions in the liver had a worse prognosis, regardless of N status; they suggested that multifocal ICCA should be assigned to Stage I Va12,13. Lesions usually reflect the hematogenous intrahepatic spread (liver metastasis) from a primary predominant tumoral liver lesion, and the clinical prognosis is expected to be poor, more similar to M1 disease than to early stages. In AJCC.v8, multifocal ICCA without lymphatic metastasis was classified as Stage II, while patients (if N1) were divided into Stage IIIb (Supplementary Table S1)
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