Treatment outcomes and prognostic factors of intrahepatic cholangiocarcinoma

The aim of the present study was to determine the treatment outcome andprognostic factors for survival in patients with peripheral intrahepatic cholangiocarcinoma(ICC). A retrospective chart review was performed for patients diagnosed withICC between 2000 and 2009 at a single institution. We identified a total of 105patients with ICC. Among them, 63.8% were older than 60 years of age, 50.5% weremale and 88.6% were Caucasian. By preoperative imaging approximately half of thepatients (50.5%) were surgical candidates and underwent resection. The other halfof the patients (49.5%) were unresectable. The unresectable group received chemoradiotherapy(53%) and transarterial chemoembolization (7.7%) as palliative treatments while23.0% of the patients (12/52) received best supportive care alone. The mediansurvival rates were 16.1 months (13.1‑19.2) for the entire cohort, 27.6 months(17.7-37.6) for curative resection, 12.9 months (6.5-19.2) for palliative chemoradiotherapyand 4.9 months (0.4-9.6) for best supportive care (p<0.001). Independent predictorson multivariate analysis were advanced stage at diagnosis and treatment received.In those patients who underwent resection, advanced AJCC stage and presence ofmicrovascular invasion were also independent predictors of poor survival. We concludedthat surgery offers the most beneficial curative option and outcome, emphasizingthe importance of resectability as a major prognostic factor. The present studyalso revealed that use of chemoradiotherapy in the adjuvant setting failed toimprove survival but its palliative use in those patients with unresectable ICCoffered a modest survival advantage over best supportive care. The overridingfactors influencing outcome were stage and the presence of microvascular invasionon pathology.