Synergistic impact of resection margin and microscopic vascular invasion for patients with HBV-related intrahepatic cholangiocarcinoma

ABSTRACT

Objectives

The resection margin (RM) status and microscopic vascular invasion (MVI) are known prognostic factors for intrahepatic cholangiocarcinoma (ICC). An enhanced understanding of their impact on long-term prognosis is required to improve oncological outcomes.

Methods

A total of 711 consecutive patients who underwent curative liver resection for hepatitis B virus–related ICC were retrospectively analyzed. The different impact of the RM status (narrow, <1 cm, or wide, ≥1 cm) and MVI (positive, +, or negative, -) on overall survival (OS) and recurrence-free survival (RFS) were analyzed.

Results

The 1-, 3-, and 5-year OS rates were 67.6%, 42.5%, and 33.2% in wide RM & MVI (-), 58.0%, 36.1%, and 26.5% in narrow RM & MVI (-), 51.0%, 27.0%, and 24.3% in wide RM & MVI (+), and 39.0%, 20.4% and 14.3% in narrow RM & MVI (+) (p < 0.001). Multivariate analysis showed that RM & MVI were independent risk factors for the OS and RFS.

Conclusion

Combined analysis of RM and MVI can better stratify the risks of postoperative death and recurrence in patients with HBV-related ICC, which may help subsequent adjuvant therapy and closer follow-up.

KEYWORDS:

• Intrahepatic cholangiocarcinoma
• resection margin
• microscopic vascular invasion
• overall survival
• recurrence-free survival

Abbreviations

ICC, intrahepatic cholangiocarcinoma; HBV, hepatitis B virus; TBIL, total bilirubin; ALB, albumin; ALT, alanine aminotransferase; AST, aspartate transaminase; GGT, Gamma-glutamyltransferase; PT, prothrombin time; AFP, Alpha-fetoprotein; WRM, wide resection margin; NRM, narrow resection; MVI, microscopic vascular invasion; CI, confidence interval; HR, hazard ratio.

Declaration of interest

No potential conflict of interest was reported by the author(s).

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationship to disclose

Authors contributions

We Lu, P Chen and K Yan contributed equally to this work. H Zhang had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: H Zhang and Y Fu. Acquisition, analysis, or interpretation of data: W Lu, P Chen and K Yan. Drafting of the manuscript: W Lu and P Chen. Critical revision of the manuscript for important intellectual content: Y Wu. Statistical analysis: L Liang. Administrative, technical, or material support: J Yuan. All authors agree to be accountable for all aspects of the work.

Additional information

Funding

This paper was funded by the Natural Science Foundation of Shanghai (No.14411964000).