What Makes Recurrence More Likely After Hepatectomy in Intrahepatic Cholangiocarcinoma?

Roughly 10% of all primary liver cancers are the result of intrahepatic cholangiocarcinoma (iCCA), in which surgery is the only potential cure. However, even when patients are referred to surgical centers with experience in these complex procedures, tumors recurrence is common, and outcomes are often poor. Thus, oncologists see both multimodal treatment options that combine surgery with chemotherapy, radiotherapy, and other treatments for iCCA, as well as a greater understanding of what factors are linked to the return of cancer.

Only about 40% of patients with iCCA are candidates for curative resection, because often the disease is already metastatic by the time it is diagnosed. According to a study appearing September 2021, about 50% of patients are diagnosed with locally advanced disease, in which the cancer has already invaded the surrounding organs and major vascular structures. “Patients without vascular invasion had a median survival of 41.0 months versus 20.0 months for those with vascular invasion,” wrote the authors.

A new study from authors at the University of Toronto, appearing in the Annals of Surgical Oncology, finds that despite recent advances, recurrence of iCCA after hepatectomy can be 50% to 70%, and about half these recurrences happen within 2 years. Their review sought to identify the factors that can predict the return of cancer within a 2-year span.

The study examined data from 10 studies involving 4158 patients, covering a period from 1990 to 2016. The authors stated that in the risk-of-bias assessment of patients who had early return of cancer after iCCA resection, 6 studies were low risk and 4 were moderate risk; 9 studies were pooled for the meta-analysis.

The following post-operative characteristics were identified as increasing the risk of early recurrence of iCCA, which was defined as cancer returning within 24 months: multiple tumors, microvascular invasion, macrovascular invasion, lymph mode metastasis, and R1 resection, which means that all macroscopic disease is removed but microscopic margins are positive. According to the authors, “the opposite was observed” when patients received adjuvant chemotherapy and/or radiation therapy following therapy.

Of the preoperative factors, cirrhosis of the liver, gender, and a patient’s hepatitis B status was not associated with early recurrence or 24-month disease-free survival.

“The findings from this systematic review could allow for improved surveillance, prognostication, and treatment decision-making for patients with resectable iCCAs” the authors wrote. “Further well-designed prospective studies are needed to explore prognostic factors for iCCA [early recurrence] with a focus on preoperative variables.”

Reference

Choi WJ, Williams PJ, Claasen MP, et al. Systematic review and meta-analysis of prognostic factors for early recurrence in intrahepatic cholangiocarcinoma after curative-intent resection. Ann Surg Oncol. Published online February 18, 2022. doi: 10.1245/s10434-022-11463-x