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Impact of microvascular invasion on clinical outcomes after curative‐intent resection for intrahepatic cholangiocarcinoma
Author(s) -
Hu LiangShuo,
Weiss Matthew,
Popescu Irinel,
Marques Hugo P.,
Aldrighetti Luca,
Maithel Shishir K.,
Pulitano Carlo,
Bauer Todd W.,
Shen Feng,
Poultsides George A.,
Soubrane Oliver,
Martel Guillaume,
Koerkamp B. Groot,
Itaru Endo,
Pawlik Timothy M.
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25305
Subject(s) - medicine , hazard ratio , perineural invasion , vascular invasion , intrahepatic cholangiocarcinoma , metastasis , gastroenterology , incidence (geometry) , surgery , confidence interval , cancer , physics , optics
Background Microvascular invasion (MiVI) is a histological feature of intrahepatic cholangiocarcinoma (ICC) that may be associated with biological behavior. We sought to investigate the impact of MiVI on long‐term survival of patients undergoing curative‐intent resection for ICC. Methods A total of 1089 patients undergoing curative‐intent resection for ICC were identified. Data on clinicopathological characteristics, disease‐free survival (DFS), and overall survival (OS) were compared among patients with no vascular invasion (NoVI), MiVI, and macrovascular invasion (MaVI). Results A total of 249 (22.9%) patients had MiVI, while 149 (13.7%) patients had MaVI (±MiVI). MiVI was associated with higher incidence of perineural, biliary and adjacent organ invasion, and satellite lesions (all P < 0.01). On multivariable analysis, MiVI was an independent risk factor of DFS (hazard ratios [HR] 1.5; 95%confidence intervals [CI], 1.3‐1.9; P < 0.001), but not OS (HR 1.1; 95%CI, 0.9‐1.3; P = 0.379). While MiVI and MaVI patients had similar DFS (median, MiVI 14.0 vs MaVI 12.0 months, HR 0.9; 95%CI, 0.7‐1.2; P = 0.377), OS was better among MiVI patients (median, MiVI 39.0 vs MaVI 21.0 months, HR 0.7; 95%CI, 0.5‐0.8; P = 0.002). Whereas nodal metastasis, R1 margin, and postoperative morbidity were associated with early death (≤18 months) among patients with MiVI, only nodal metastasis was associated with late (>18 months) prognosis. Conclusions Roughly 1 out of 5 patients with resected ICC had MiVI. MiVI was associated with advanced tumor characteristics and a higher risk of tumor recurrence.