title: Molecular factors associated with recurrence and survival following hepatectomy in patients with intrahepatic cholangiocarcinoma: a guide to adjuvant clinical trials.
abstract: BACKGROUND
  This study sought to determine clinical and molecular factors related to recurrence and survival in patients with ICC following hepatectomy.
  
  
  METHODS
  Database review identified 34 patients. Molecular markers (Ki67, p53, beta-catenin) and standard pathological evaluations were performed.
  
  
  RESULTS
  The most common resections were right (n = 11), extended right (n = 8), and left hepatectomy (n = 7). The 30- and 90 -day mortality rates were 5.9% and 11.8%. The median tumor size was 7.8 cm. Nine patients (26.5%) had positive lymph nodes and ten patients (29.4%) received adjuvant therapy. Median follow up was 33.5 months. The median disease-free interval was 6 months. The median overall survival was 37.9 months. Univariate predictors of recurrence were tumor size (P = 0.02) and differentiation (P = 0.05). On multivariate analysis, differentiation (P = 0.03; OR = 0.38; 95% CI: 0.17-0.89) remained significant. Univariate predictors of survival were tumor size (P = 0.02), lymphovascular invasion (P = 0.02), satellite nodules (P = 0.006), beta-catenin expression (P = 0.008), and recurrence (P = 0.026). On multivariate analyses, satellite lesions (P = 0.05, OR = 3.15, 95% CI: 0.96-10.4) and beta-catenin (P = 0.04, OR = 3.23; 95% CI: 1.1-9.7) remained significant and differentiation (P = 0.045; OR = 0.42; 95% CI: 0.18-0.98) was an additional predictor.
  
  
  CONCLUSIONS
  Future clinical trials could include certain molecular and pathologic factors to assist in determining the necessity and type of adjuvant therapy.
authors.affiliation: From the Division of Surgical Oncology, Department of Surgery, University of Louisville and The James Graham Brown Cancer Center, Louisville, Kentucky.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Schiffman
authors.forename: Michael R
authors.initials: MR
authors.lastname: Nowacki
authors.forename: Lena
authors.initials: L
authors.lastname: Spencer
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000378:metabolism / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D016158:Genes, p53; D006498:Hepatectomy; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D012042:Registries; D051176:beta Catenin / Q000378:metabolism
chemical_list: D019394:Ki-67 Antigen; D051176:beta Catenin
keywords: Cholangiocarcinoma; beta-catenin; bile duct cancer