Prognostic Risk Factors Associated with Recurrence and Metastasis After Radical Resection in Patients with Hepatolithiasis Complicated by Intrahepatic Cholangiocarcinoma.

Abstract

The objective of this study was to analyze the predictive significance of different prognostic factors associated with recurrence and metastasis after the radical resection in patients with hepatolithiasis complicated by intrahepatic cholangiocarcinoma (HLA/IHCC). A total of 138 patients with HLA/IHCC admitted during April 2006-April 2009 were selected for this study and they were divided into two groups, with and without recurrence/metastasis. After a radical resection surgery, the patients were followed up for 5years to monitor the recurrence and/or metastasis. The general and clinical data of the two groups were analyzed to evaluate the relevant risk factors. The study showed that recurrence/metastasis occurred in 48 patients with a rate of 34.8%. Recurrence in liver accounted for 85.4% (41 cases), whereas in lung and bone metastases occurred at rates of 8.3% (4 cases) and 6.3% (3 cases), respectively. Univariate analysis revealed that CA19-9, tumor diameter, tumor amount, lymphatic metastasis, and AJCC stage of the recurrence/metastasis group were significantly different from those of the non-recurrence/metastasis patients (p<0.05). The multivariate analysis showed that CA19-9>200U/mL, tumor diameter >5cm, presence of multiple tumors, lymphatic metastasis, and III-IV AJCC stages were independent risk factors of tumor recurrence and metastasis after the radical surgery (p<0.05). During the 5years of follow-up, 65 patients (47.1%) died, including 31 in the recurrence/metastasis and 34 in the non-recurrence/metastasis groups, accounting for 64.5% (31/48) and 37.8% (34/90) of mortality in the two groups, respectively. Thus, the 5-year mortality in the recurrence/metastasis group was significantly higher than that in the non-recurrence/metastasis group (p<0.05). The CA19-9 antigen, tumor diameter, tumor amount, lymphatic metastasis, and AJCC stage were significantly associated with increased risk of post-resection recurrence and metastasis of HLA/IHCC. The massive lymphadenectomy during the surgery and perioperative control of inflammation decreased the risk of recurrence/metastasis and further improved the disease prognosis.