Prognostic factors and preoperative therapy in resectable intrahepatic cholangiocarcinoma

Polyakov AN, Patyutko YuI, Granov DA, et al. Prognostic factors and preoperative therapy in resectable intrahepatic cholangiocarcinoma. Pirogov Russian Journal of Surgery. 2025;(1):5‑13. (In Russ., In Engl.)
https://doi.org/10.17116/hirurgia20250115

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To identify prognostic factors and role of preoperative therapy for resectable intrahepatic cholangiocarcinoma (IHCC).

MATERIAL AND METHODS

We analyzed the results of surgical and combined treatment of IHCC between 1999 and 2023. Immediate and long-term outcomes were evaluated depending on negative prognostic factors and additional therapy.

RESULTS

The study included 195 patients. Postoperative complications grade ≥III were observed in 35 (17.9%) case. Mortality rate was 3.1% (n=6). Thirty-eight patients (19.5%) underwent treatment before surgery, 109 (55.9%) ones — after surgery. The median overall survival was 31 months, 5-year overall survival — 32.0%. The following factors worsened overall survival: node size ≥8 cm (HR 1.45; 95% CI 0.97—2.17), invasion (HR 1.63; 95% CI 1.07—2.47), multiple lesion (HR 1.51; 95% CI 1.00—2.28). R1 resection worsened disease-free survival (HR 1.88; 95% CI 1.14—3.10). Lymph node metastases decreased overall (HR 1.96; 95% CI 1.27- 3.04) and disease-free survival (HR 2.37; 95% CI 1.63—3.44). Two and more negative factors worsened overall (p=0.0013) and disease-free survival (p=0.0005). Absence of adjuvant therapy worsened overall (HR 2.12; 95% CI 1.41—3.20) and disease-free survival (HR 1.42; 95% CI 0.99—2.04). There was a trend towards higher overall (p=0.088) and progression-free survival (p=0.029) in case of preoperative therapy (n=195). In unfavorable prognosis group, preoperative therapy (n=33) was superior to standard treatment (resection+capecitabine after surgery, n=26). There was a trend towards higher overall survival (p=0.066) and significantly better progression-free survival (17 vs 13 months, p=0.018).

CONCLUSION

Negative prognostic factors for resectable IHCC are lesion size ≥8 cm, intrahepatic and regional metastases, invasion into neighboring structures, R1 resection. Combination of negative factors worsened prognosis. Adjuvant therapy improved postoperative outcomes. Preoperative therapy may be advisable in case of negative factors and high risk of R1 resection.

Keywords:

biliary cancer

liver resection

combined treatment

neoadjuvant therapy

adjuvant therapy

Authors:

Polyakov A.N.

Blokhin National Cancer Research Center

SPIN RSCI: 9924-0256
Scopus AuthorID: 57190413973
ORCID: 0000-0001-5348-5011

Patyutko Yu.I.

Blokhin National Medical Research Center of Oncology

RSCI AuthorID: 137980
Scopus AuthorID: 55666204300
ORCID: 0000-0001-9254-1346

Granov D.A.

Blokhin National Cancer Research Center

ORCID: 0000-0002-8746-8452

Bazin I.S.

Blokhin National Cancer Research Center

ORCID: 0000-0003-2624-9341

Rutkin I.O.

Blokhin National Cancer Research Center

ORCID: 0000-0002-9018-0433

Korshak A.V.

Blokhin National Medical Cancer Research Center

ORCID: 0009-0002-8236-2808

Turlak A.S.

Granov Russian Research Center of Radiology and Surgical Technologies

ORCID: 0000-0002-2207-767X

Podluzhny D.V.

Blokhin National Medical Cancer Research Center

SPIN RSCI: 3537-3436
Scopus AuthorID: 6506558313
ORCID: 0000-0001-7375-3378

Received:

09.04.2024

Accepted:

23.04.2024

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