Does gross appearance indicate prognosis in intrahepatic cholangiocarcinoma?

Background and Objectives Survival after surgery for intrahepatic cholangiocarcinoma (ICC) is usually poor. The objective of this study was to investigate whether the gross appearance of ICC indicates postoperative prognosis. Methods Seventy patients with ICC underwent hepatectomy, with a 50% curative resection rate. Tumors were classified according to gross appearance [mass-forming (n = 28), periductal-infiltrating (n = 14), intraductal growth (n = 10), and mass-forming plus periductal-infiltrating (n = 18)], and the presence of lymph node or intrahepatic metastasis was studied microscopically. Results The incidence of positive lymph nodes was significantly higher in the patients with mass-forming plus periductal-infiltrating tumors than in those with intraductal growth tumors (P = 0.0089). The curative resection rate was significantly lower in patients with mass-forming plus periductal-infiltrating tumors than in those with either mass-forming or intraductal growth tumors (P = 0.0001, P = 0.0048, respectively). The 5-year survival rate after surgery in patients with mass-forming plus periductal-infiltrating tumors (0%) was significantly lower than that in patients with mass-forming tumors (39%) or intraductal growth tumors (69%) (P = 0.0036, P = 0.0011, respectively). Multivariate analysis using Cox's hazards model revealed that lymph node metastasis (P = 0.0109) and curative resection (P = 0.0315) were statistically significant independent prognostic factors; however, macroscopic types were not. Conclusions Patients with mass-forming plus periductal-infiltrating ICCs have a poor prognosis; however, the macroscopic types may not be a statistically significant independent prognostic factor. J. Surg. Oncol. 1998;69:162–167. © 1998 Wiley-Liss, Inc.