title: Recurrence after operative management of intrahepatic cholangiocarcinoma.
abstract: BACKGROUND
  Data on recurrence after operation for intrahepatic cholangiocarcinoma (ICC) are limited. We sought to investigate rates and patterns of recurrence in patients after operative intervention for ICC.
  
  
  METHODS
  We identified 301 patients who underwent operation for ICC between 1990 and 2011 from an international, multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed.
  
  
  RESULTS
  During the median follow up duration of 31 months (range 1-208), 53.5% developed a recurrence. Median RFS was 20.2 months and 5-year actuarial disease-free survival, 32.1%. The most common site for initial recurrence after operation of ICC was intrahepatic (n = 98; 60.9%), followed by simultaneous intra- and extrahepatic disease (n = 30; 18.6%); 33 (21.0%) patients developed extrahepatic recurrence only as the first site of recurrence. Macrovascular invasion (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.34-3.21; P < .001), nodal metastasis (HR, 1.55; 95% CI, 1.01-2.45; P = .04), unknown nodal status (HR, 1.57; 95% CI, 1.10-2.25; P = .04), and tumor size ≥ 5 cm (HR, 1.84; 95% CI, 1.28-2.65; P < .001) were independently associated with increased risk of recurrence. Patients were assigned a clinical score from 0 to 3 according to the presence of these risk factors. The 5-year RFS for patients with scores of 0, 1, 2, and 3 was 61.8%, 36.2%, 19.5%, and 9.6%, respectively.
  
  
  CONCLUSIONS
  Recurrence after operative intervention for ICC was common. Disease recurred both at intra- and extrahepatic sites with roughly the same frequency. Factors such as lymph node metastasis, tumor size, and vascular invasion predict highest risk of recurrence.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.forename: Ioannis
authors.initials: I
authors.lastname: Hatzaras
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Sorin
authors.initials: S
authors.lastname: Alexandrescu
authors.forename: Hugo
authors.initials: H
authors.lastname: Marques
authors.forename: Carlo
authors.initials: C
authors.lastname: Pulitano
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barroso
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Ferrone
authors.forename: Andrew X
authors.initials: AX
authors.lastname: Zhu
authors.forename: Todd W
authors.initials: TW
authors.lastname: Bauer
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Walters
authors.forename: Ryan
authors.initials: R
authors.lastname: Groeschl
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Nguyen
authors.forename: Ryan
authors.initials: R
authors.lastname: Turley
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
authors.forename: Catherine
authors.initials: C
authors.lastname: Hubert
authors.forename: Stephanie
authors.initials: S
authors.lastname: Meyer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Gigot
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000517:prevention & control; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors