ARTERIAL ENHANCEMENT PATTERN PREDICTS SURVIVAL IN PATIENTS WITH BOTH UNRESECTABLE AND RESECTED INTRAHEPATIC CHOLANGIOCARCINOMA
Bradford J. Kim*, Elena Panettieri, Yoshikuni Kawaguchi, Hyunseon C. Kang, Veronica Cox, Eugene Koay, Kanwal Raghav, Ahmed Kaseb, Eduardo A. Vega, Takashi Mizuno, Shubham Pant, Milind Javle, Jean-Nicolas Vauthey
University of Texas MD Anderson Cancer Center, Houston, TX
Background: Intrahepatic cholangiocarcinoma (IHCC) is a heterogeneous disease, and there is wide variability in outcome. Previous studies have shown an association between vascularity and prognosis in resectable IHCC, but the prognostic utility of early arterial enhancement in unresectable IHCC has not been reported. The aim of this study was to determine if arterial hypervascularity confers a prognostic benefit in patients with unresectable IHCC and to corroborate previously reported positive prognostic effect in patients who underwent resection for IHCC.
Methods: All patients treated at single institution for mass-forming IHCC between 2003 and 2015, and who had contrast-enhanced computed tomography (CT) at the time of diagnosis were identified for analysis. Patients were divided into a resected Surgical and an unresectable (due to local advanced or metastatic disease) Medical cohort. After review by two radiologists (C.K. and V.C.), tumor vascularity was classified as Hypervascular (>50%), Peripherally Enhancing (10-50%), or Hypovascular (<10%), based on degree of enhancement. Overall survival was the primary outcome.
Results: Overall, the cohort analyzed included 145 patients (Medical n=89; Surgical n=55;), with a mean age of 61 years. Unresectable patients were more frequently male (55.2% vs. 32.1%, p=0.01), had a higher level of CA 19-9 at diagnosis (5470.7 ± 18826.8 U/mL vs. 629.4 ± 2570.9 U/mL, p=0.0018), with larger radiologic tumor size (mean: 10.8 ± 3.8 cm vs. 6.3 ± 2.8 cm, p<0.001). In both the Medical and Surgical cohorts, OS was significantly higher in patients with hypervascular tumors when compared to hypovascular tumors (Figure 1, Medical: p=0.030; Figure 2, Surgical p=0.038), while there was no significant difference between tumors in the hypervascular and peripherally enhancing groups (Medical: p=0.096; Surgical p=0.157) or between tumors in the peripherally enhancing and hypovascular groups (Medical: p=0.396; Surgical p=0.297).
Conclusion: In resectable and unresectable patients with IHCC, arterial phase hypervascularity on CT can be utilized as a surrogate for prognosis. Appropriate preoperative imaging predicts favorable survival in thirty percent of patients undergoing resection for IHCC.
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