Clinicopathologic and treatment-related factors influencing recurrence and survival after hepatic resection of intrahepatic cholangiocarcinoma: a 19-year experience from an established Australian hepatobiliary unit.

Background: Intrahepatic cholangiocarcinoma is rare, but its incidence is rapidly increasing in developed countries. Early detection and surgical extirpation offer the only hope for cure. Given the rarity of intrahepatic cholangiocarcinoma, there is limited knowledge regarding its natural history, clinicopathological characteristics, or outcomes following surgery. The primary aim of the current study is to report overall survival and recurrence-free survival outcomes following resection of intrahepatic cholangiocarcinoma. The secondary aim is to evaluate the impact of prognostic variables on outcomes.
Methods: Between November 1990 and November 2009, 88 patients were evaluated for their suitability for potentially curative surgery; of these, 40 patients underwent potentially curative surgery. These patients are the principal subjects of the current analysis. Patients were assessed at monthly intervals for the first 3 months and then at six monthly intervals after treatment. Recurrence-free survival and overall survival were determined; 17 clinicopathological and treatment-related factors associated with recurrence-free survival and overall survival were evaluated through univariate and multivariate analyses.
Results: No patient was lost to follow-up. The median follow-up was 31 months (range = 0-142 months). The median recurrence-free survival and overall survival after resection were 21 and 33 months, respectively. The 5-year survival rate was 28%. Four factors were associated with overall survival: carbohydrate antigen 19.9 (p = 0.020), clinical stage (p = 0.018), histological grade (p = 0.020), and lymph node metastases (p = 0.003). Two factors were associated with recurrence-free survival: carbohydrate antigen 19.9 (p = 0.002) and margin status (p = 0.002).
Conclusion: Hepatic resection is an efficacious treatment for intrahepatic cholangiocarcinoma. Clincopathological factors can predict outcome and should be used in the preoperative assessment of operability.