Prognostic factors for patients with mass-forming intrahepatic cholangiocarcinoma:A case series of 68 patients

BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer in humans after hepatocellular carcinoma and a rare epithelial malignancy that results in a poor prognosis.According to the Liver Cancer Study Group of Japan classification,ICC can be divided into three types:Mass-forming(MF)type,periductal-infiltrating(PI)type,and intraductal-growth type.The MF type is the most common,accounting for 57.1-83.6%of ICCs.Nevertheless,little is known about the epidemiology and treatment of MF ICC.AIM To examine the prognostic factors for patients with MF ICC.METHODS We carried out a retrospective analysis of consecutive patients with MF ICC treated at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital between January 2008 and December 2018.According to the treatment received,the patients were divided into either a resection group or an exploration group.RESULTS The pooled 1-,3-,and 5-year survival rates in the 68 patients with MF ICC were 66.5%,36.3%,and 9.3%,respectively.Univariate analysis revealed that surgical resection(P<0.001),nodal metastasis(P<0.001),tumor location(P=0.039),vascular invasion(P<0.001),ascites(P<0.001),and differentiation(P=0.009)were significantly associated with the prognosis and survival of MF ICC.Multivariate analysis revealed that ascites(hazard ratio[HR]=5.6,95%confidence interval[CI]:1.6-18.9,P=0.006)and vascular invasion(HR=2.5,95%CI:1.0-6.1,P=0.045)were independent risk factors for MF ICC.The pooled 1-,3-,and 5-year survival rates in the 19 patients of the exploration group were 5.3%,5.3%,and 0,respectively.Among the 49 patients who underwent surgical resection,the pooled 1-,3-,and 5-year survival rates were 93.5%,49.7%,and 14.4%,respectively.Univariate and multivariate analyses revealed that vascular invasion(HR=3.1,95%CI:1.2-8.5,P=0.024)and nodal metastasis(HR=3.2,95%CI:1.4-7.6,P=0.008)were independent prognostic risk factors for surgical resection patients.CONCLUSION The prognosis of MF ICC patients is dismal,especially those with ascites or vascular invasion.Surgical resection is a key factor in improving overall survival in patients with MF ICC,and vascular invasion and lymph node metastasis affect the efficacy of surgical resection.

Role of routine lymph node dissection alongside resection ofintrahepatic cholangiocarcinoma: Systematic review and metaanalysis

BACKGROUND The global incidence of intrahepatic cholangiocarcinoma(ICCA)is soaring.Due to often delayed presentation,only a narrow spectrum of the disease is usually surgically resectable.To more accurately stage the disease,reduce recurrence,and improve overall survival,surgical teams are increasingly performing intraoperative lymph node dissection(LND)as well.This procedure has its associated morbidity,while there is no consensus or formal guidelines on its role in this setting.Hence,there is a need to better delineate the evidence for performing LND alongside surgical resection of the ICCA.AIM To perform a systematic review and meta-analysis on the role of LND in improving prognostication and survival post-resection of ICCA.METHODS We performed a systematic literature search using Pubmed,Medline,Embase,and the Cochrane Library,for all studies involving LND,ICCA,and surgical resection using several keywords,Medical Subject Headings(MeSH)tags,and appropriate synonyms.All clinical studies comparing curative intent resection of ICCA with LND vs resection without LND were included,while single-arm case series,studies with insufficient data,and duplicates were excluded.We included all English-language studies from the different academic databases up till early December 2022.The primary outcome measures were set for overall survival(OS)and disease-free survival(DFS).RESULTS This systematic review and meta-analysis included 15 studies that fulfilled the selection criteria comprising 11413 patients with surgically-resectable ICCA,of whom 6424(56.3%)underwent hepatectomy with LND while the remainder underwent hepatectomy only.In patients who underwent LND,on average,27.7%of the resected lymph nodes were positive for metastatic disease.Overall,the results showed that performing LND did not significantly improve OS or DFS.However,the effect of LND on OS showed a degree of variability by geographical region,in Eastern and Western countries.As LND is increasingly being performed,further time-based analysis was undertaken to identify time-dependent changes in the role of LND.An increasing adoption of LND was not associated with improved OS.Furthermore,no roles were identified for neoadjuvant/adjuvant chemotherapy or increasing lymph node retrieval in improving OS either.CONCLUSION LND might aid in staging,prognosticating,and deciding further management of resected ICCA,but does not improve OS and DFS and is unsuitable for high-risk patients unlikely to benefit from further treatments.