title: Staging, prognostic factors and adjuvant therapy of intrahepatic cholangiocarcinoma after curative resection.
abstract: OBJECTIVE
  Prognostic factors and adjuvant therapy of intrahepatic cholangiocarcinoma (ICC) after curative resection were not clear. We aim to analyse prognostic factors after curative resection and evaluate adjuvant therapy and survival based on the new staging system.
  
  
  METHODS
  A retrospective analysis of 283 patients who underwent surgical exploration for ICC was performed. Staging was performed according to the 7th edition AJCC staging manual. Univariate and multivariate analyses were used to evaluate independent prognostic factors.
  
  
  RESULTS
  The difference for OS at different TNM stages after R0 resection was significant (P < 0.001). Despite regional lymph node metastasis, tumour number and vascular invasion, serum GGT level was also an independent prognostic factor for OS of patients after R0 resection. The incidence of biliary and vascular invasion was significantly higher in high GGT group than in normal GGT group. Factors predictive of recurrence were multiple tumours and regional lymph node metastasis. After R0 resection, adjuvant TACE not only did not improve the OS of patients at TNM stage I (P = 0.508), but significantly promoted recurrence of these patients (P = 0.006). Only patients at TNM stage II, III and IV benefited from adjuvant TACE for longer survival, while the recurrence rates were not affected.
  
  
  CONCLUSIONS
  The new staging system can predict the survival of ICC patients after R0 resection. High GGT level may be suggestive of biliary and vascular invasion and was an independent risk factor for OS after R0 resection. Adjuvant TACE may be indicated only for patients at advanced stages for better survival.
authors.affiliation: Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Lun-Xiu
authors.initials: LX
authors.lastname: Qin
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.forename: Hui-Chuan
authors.initials: HC
authors.lastname: Sun
authors.forename: Shuang-Jian
authors.initials: SJ
authors.lastname: Qiu
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Ye
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D014408:Biomarkers, Tumor / Q000097:blood; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000097:blood / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D014408:Biomarkers, Tumor; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human
keywords: adjuvant therapy; intrahepatic cholangiocarcinoma; prognosis; recurrence; risk factors