Patterns and risk factors of early recurrence after radical resection for intrahepatic cholangiocarcinoma

Abstract

BACKGROUND

Intrahepatic cholangiocarcinoma (ICC) represents the second-most prevalent primary hepatic malignancy, demonstrating increasing worldwide occurrence. Although surgical methods have progressed, outcomes following curative resection remain suboptimal due to substantial recurrence frequencies. Recurrence occurring early, usually during the initial postoperative year, indicates aggressive tumor characteristics and predicts inferior outcomes compared with delayed recurrence. Comprehending patterns and predictive indicators of early relapse is essential for refining postoperative monitoring approaches and directing adjuvant treatment choices. The present investigation concentrated on determining risk indicators and recurrence characteristics to enhance personalized patient management strategies for ICC.

AIM

To determine the characteristics and predictive indicators of early disease recurrence following curative surgical resection of ICC.

METHODS

We conducted a retrospective evaluation of 386 consecutive individuals who received curative surgical resection for ICC at our institution during the period spanning January 2017 through December 2021. Early disease recurrence was operationally defined as tumor relapse occurring within the first 12 postoperative months. Predictive indicators were examined through univariate and multivariate Cox proportional hazards regression analyses.

RESULTS

Within our cohort of 386 individuals, 237 patients (61.4%) demonstrated disease recurrence throughout the observation period, with 178 cases (75.1%) manifesting early recurrence. The predominant anatomical locations of recurrent disease included hepatic tissue (66.7%), regional lymph nodes (18.1%), and peritoneal surfaces (8.0%). Independent predictive indicators of early recurrence encompassed: Neoplasm diameter exceeding 5 cm [hazard ratio (HR) = 2.14, 95% confidence interval (CI): 1.52-3.01, P < 0.001], presence of multiple tumor foci (HR = 1.89, 95%CI: 1.34-2.67, P < 0.001), metastatic lymph node involvement (HR = 2.43, 95%CI: 1.71-3.45, P < 0.001), microscopic vascular invasion (HR = 1.76, 95%CI: 1.25-2.48, P = 0.001), carbohydrate antigen 19-9 concentrations surpassing 200 U/mL (HR = 1.92, 95%CI: 1.37-2.69, P < 0.001), and incomplete surgical margins (HR = 2.01, 95%CI: 1.38-2.93, P < 0.001). Individuals experiencing early recurrence demonstrated markedly reduced overall survival relative to those with delayed recurrence (median: 18.5 months vs 42.3 months, P < 0.001).

CONCLUSION

Early disease recurrence following ICC resection occurs frequently and correlates with unfavorable clinical outcomes. Several neoplasm-associated and treatment-associated characteristics predict early relapse. These indicators can facilitate identification of patients at elevated risk who might benefit from intensive monitoring protocols or adjuvant therapeutic interventions.

Keywords: Intrahepatic cholangiocarcinoma; Early recurrence; Radical resection; Risk factors; Prognosis; Survival

Core Tip: Intrahepatic cholangiocarcinoma demonstrates substantial susceptibility to early postoperative recurrence, which profoundly compromises clinical prognosis. Within this extensive retrospective investigation involving 386 participants, 46.1% manifested early disease recurrence during the initial 12 postoperative months, exhibiting a median overall survival duration of merely 18.5 months. Six autonomous predictive indicators were determined: Neoplasm diameter exceeding 5 cm, multiple lesions, metastatic lymph node involvement, microscopic vascular invasion, carbohydrate antigen 19-9 exceeding 200 U/mL, and R1 resection status. An innovative risk assessment framework successfully stratified individuals into low-, intermediate-, and high-risk categories, facilitating personalized surveillance protocols and adjuvant treatment strategies to optimize postoperative outcomes in intrahepatic cholangiocarcinoma management.