CONDITIONAL RECURRENCE ANLYSIS OF INTRAHEPATIC CHOLANGIOCARCINOMA: CHANGES IN RECURRENCE RATE AND SURVIVAL AFTER RECURRENCE RESECTION BY THE TIME INTERVAL WITHOUT RECURRENCE
Harufumi Maki*, Yoshikuni Kawaguchi, Rihito Nagata, Yuichiro Mihara, Akihiko Ichida, Takeaki Ishizawa, Nobuhisa Akamatsu, Junichi Kaneko, Junichi Arita, Kiyoshi Hasegawa
Hepatobiliary-Pancreatic Surgery Division, Department of Surgery, Tokyo Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Bunkyo-ku, Tokyo, Japan
[Background] The prognosis of intrahepatic cholangiocarcinoma (ICC) is dismal and the recurrent rate is high. The benefit of re-resection of recurrent ICC remains unknown.
[Patients and Methods] Patients who underwent hepatectomy for ICC during 19952020 were included. A Cox proportional hazards model analyses were performed to identify risk factors for recurrence-free-survival (RFS) in patients undergoing initial resection and overall survival (OS) in patients who developed recurrence after initial resection. Conditional cumulative incidence of recurrence was assessed.
[Results] A total of 169 patients were included in the study and 114 patients (67.5%) developed recurrence. Conditional cumulative recurrence rate showed that the 5-year recurrence rate was 69.3% at the time of initial resection, 24.8% in patients free from recurrence at 2 years after initial resection, and 2.6% in patients free from recurrence at 4 years (Figure 1). Of the 114 recurrent patients, 26 (22.8%) underwent re-resection of recurrence (resection of liver alone [n=15] and resection of liver and extrahepatic sites [n=11]). The median OS (interquartile range) was significantly longer in the re-resection group than in the non-re-resection group: 5.8 (4.9not reached) years vs. 1.8 (1.02.8) years (p<.001). A multivariable Cox proportional hazards model analyses in 114 patients with recurrent ICC revealed re-resection (hazard ratio [HR] 0.21; 95% confidence interval [CI] 0.110.40, p<.001), microscopic portal invasion (HR 2.13; CI 1.074.24, p=0.031) and time interval without recurrence (month) (HR 0.98; CI 0.961.00, p=0.038) were significantly associated with longer OS. The 5-year OS was higher in patients who developed recurrence with longer interval from initial resection and underwent resection of recurrence for initial HCC without portal vein invasion (Figure 2).
[Conclusion] Although the recurrence rate is high in patients undergoing ICC resection, conditional cumulative recurrence rate analysis showed the recurrence rate decreased by the time interval without recurrence. Re-resection of recurrent ICC was associated with improved OS but needs attention to microscopic portal invasion of initial ICC and time interval without recurrence.
Conditional incidence of recurrence after resection of intrahepatic cholangiocarcinoma
Changes in overall survival after re-resection by time to recurrence
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