53.06 Intrahepatic Cholangiocarcinoma Tumor Burden to Predict Prognosis Following Resection

Posted on January 31, 2019

J. Cloyd2, F. Bagante2,6, G. Spolverato2, M. Weiss1, S. Alexandrescu3, H. P. Marques4, L. Aldrighetti5, S. K. Maithel7, C. Pulitano8, C. Pulitano8, T. W. Bauer9, F. Shen10, G. A. Poultsides11, O. Soubrane12, G. Martel13, B. G. Koerkamp14, A. Guglielmi6, E. Itaru15, T. M. Pawlik2  1Johns Hopkins Hospital,Surgery,Baltimore, MD, USA 2The Ohio State University Wexner Medical Center,Surgery,Columbus, OH, USA 3Fundeni Clinical Institute, Bucharest,Surgery,Bucarest, -, Romania 4Curry Cabral Hospital,Surgery,Lisbon, -, Portugal 5Ospedale San Raffaele,Surgery,Milan, -, Italy 6University of Verona,Surgery,Verona, -, Italy 7Emory University School Of Medicine,Surgery,Atlanta, GA, USA 8Royal Prince Alfred Hospital,Surgery,Sydney, -, Australia 9University Of Virginia,Surgery,Charlottesville, VA, USA 10Eastern Hepatobiliary Surgery Hospital,Surgery,Shanghai, -, China 11Stanford University,Surgery,Palo Alto, CA, USA 12Beaujon Hospital,Surgery,Clichy, -, France 13University Of Ottawa,Surgery,Ottawa, Ontario, Canada 14Erasmus University Medical Centre,Surgery,Rotterdam, -, Netherlands 15Yokohama City University School of Medicine,Surgery,Yokohama, -, Japan

Introduction: We sought to investigate the impact of total tumor-burden (i.e. size and number) on patient prognosis following resection of ICC.

Methods: Patients who underwent curative-intent resection for ICC at one of the 15 participating institutions between 2005-2016 were identified.

Results:Among 1,278 patients who underwent surgery for ICC, 423 (33.1%) patients had no lymph-node metastasis (N0), while 224 (17.5%) had nodal disease (N1); 631 (49.4%) did not have a lymphadenectomy (Nx). Median tumor size was 6 cm (inter-quartile range [IQR], 4-8). While 1,016 (81.8%) patients had a single ICC, 226 (18.2%) patients had multifocal disease. On multivariable analysis, after adjusting for lymph-node status, tumor size (logarithmic transformation: HR 1.35) and number of ICC (logarithmic transformation: HR 1.51) demonstrated a strong non-linear association with overall survival (OS)(Log-model; Figure 1). Log-model (AUC 0.588) out-performed both tumor size (c-index 0.572) and number of tumors (c-index 0.539) in predicting OS. Among N0 patients, 5-year OS of patients with a single ICC ranged from 80-70% among patients with ICC <3 cm to 50% for patients with ICC >6 cm. Conversely, among N1 patients, 5-year OS of patients with a single ICC ranged from 60-50% for patients with ICC <3 cm to 40-30% for patients with ICC 3-6 cm and 20% for patients with ICC >6 cm.

Conclusion:Tumor size and number of ICC demonstrated a strong non-linear association with survival following resection of ICC. A log-model tumor burden score may be a better tool to estimate prognosis of patients undergoing curative-intent resection of ICC.