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Recurrence Patterns and Disease-Free Survival after Resection of Intrahepatic Cholangiocarcinoma: Preoperative and Postoperative Prognostic Models.

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Doussot, A; Gonen, M; Wiggers, JK; Groot-Koerkamp, B; DeMatteo, RP; Fuks, D; Allen, PJ; Farges, O; Kingham, TP; Regimbeau, JM; D'Angelica, MI ...
Published in: J Am Coll Surg
September 2016

BACKGROUND: Liver resection is the most effective treatment for intrahepatic cholangiocarcinoma. Recurrent disease is frequent; however, recurrence patterns are ill-defined and prognostic models are lacking. STUDY DESIGN: A primary cohort of 189 patients who underwent resection for intrahepatic cholangiocarcinoma was used for recurrence patterns analysis within and after 24 months. Based on independent factors for disease-free survival identified in Cox regression analysis, preoperative and postoperative models were developed using a recursive partitioning method. Models were externally validated using a multicenter cohort of 522 resected patients (Association Française de Chirurgie intrahepatic cholangiocarcinoma study group). RESULTS: Recurrence within 24 months most often involved the liver (82.7%), and most recurrences after 24 months were strictly extrahepatic (61.1%). In multivariable analysis of the primary cohort, independent preoperative factors for disease-free survival were tumor size and multifocality (based on imaging); tumor size, multifocality, vascular invasion, and lymph node metastases (based on pathology) were independent postoperative factors. The preoperative model allowed patient classification into low-risk and high-risk groups for recurrence. In the validation cohort (n = 522), high-risk patients had a greater likelihood of recurrence (hazard ratio = 2.17; 95% CI, 1.74-2.72; p < 0.001). The postoperative model included tumor size, vascular invasion, and positive nodal disease on pathology and classified patients in low-, intermediate-, and high-risk groups in the primary cohort. As compared with low-risk patients in the validation cohort, intermediate- and high-risk patients were more likely to experience recurrence (hazard ratio = 1.9; 95% CI, 1.41-2.47; p < 0.001 and hazard ratio = 2.99; 95% CI, 2.08-4.31; p < 0.001, respectively). CONCLUSIONS: Recurrence patterns are time dependent. Both models as developed and validated in this study classified patients in distinct recurrence risk groups, which can guide treatment recommendations.

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Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

September 2016

Volume

223

Issue

3

Start / End Page

493 / 505.e2

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Humans
  • Hepatectomy
 

Citation

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Doussot, A., Gonen, M., Wiggers, J. K., Groot-Koerkamp, B., DeMatteo, R. P., Fuks, D., … Jarnagin, W. R. (2016). Recurrence Patterns and Disease-Free Survival after Resection of Intrahepatic Cholangiocarcinoma: Preoperative and Postoperative Prognostic Models. In J Am Coll Surg (Vol. 223, pp. 493-505.e2). United States. https://doi.org/10.1016/j.jamcollsurg.2016.05.019
Doussot, Alexandre, Mithat Gonen, Jimme K. Wiggers, Bas Groot-Koerkamp, Ronald P. DeMatteo, David Fuks, Peter J. Allen, et al. “Recurrence Patterns and Disease-Free Survival after Resection of Intrahepatic Cholangiocarcinoma: Preoperative and Postoperative Prognostic Models.” In J Am Coll Surg, 223:493-505.e2, 2016. https://doi.org/10.1016/j.jamcollsurg.2016.05.019.
Doussot A, Gonen M, Wiggers JK, Groot-Koerkamp B, DeMatteo RP, Fuks D, et al. Recurrence Patterns and Disease-Free Survival after Resection of Intrahepatic Cholangiocarcinoma: Preoperative and Postoperative Prognostic Models. In: J Am Coll Surg. 2016. p. 493-505.e2.
Doussot, Alexandre, et al. “Recurrence Patterns and Disease-Free Survival after Resection of Intrahepatic Cholangiocarcinoma: Preoperative and Postoperative Prognostic Models.J Am Coll Surg, vol. 223, no. 3, 2016, pp. 493-505.e2. Pubmed, doi:10.1016/j.jamcollsurg.2016.05.019.
Doussot A, Gonen M, Wiggers JK, Groot-Koerkamp B, DeMatteo RP, Fuks D, Allen PJ, Farges O, Kingham TP, Regimbeau JM, D’Angelica MI, Azoulay D, Jarnagin WR. Recurrence Patterns and Disease-Free Survival after Resection of Intrahepatic Cholangiocarcinoma: Preoperative and Postoperative Prognostic Models. J Am Coll Surg. 2016. p. 493-505.e2.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

September 2016

Volume

223

Issue

3

Start / End Page

493 / 505.e2

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Male
  • Humans
  • Hepatectomy