Can hepatic resection provide a long-term cure for patients with intrahepatic cholangiocarcinoma?
BACKGROUND
A patient can be considered statistically cured from a specific disease when their mortality rate returns to the same level as that of the general population. In the current study, the authors sought to assess the probability of being statistically cured from intrahepatic cholangiocarcinoma (ICC) by hepatic resection.


METHODS
A total of 584 patients who underwent surgery with curative intent for ICC between 1990 and 2013 at 1 of 12 participating institutions were identified. A nonmixture cure model was adopted to compare mortality after hepatic resection with the mortality expected for the general population matched by sex and age.


RESULTS
The median, 1-year, 3-year, and 5-year disease-free survival was 10 months, 44%, 18%, and 11%, respectively; the corresponding overall survival was 27 months, 75%, 37%, and 22%, respectively. The probability of being cured of ICC was 9.7% (95% confidence interval, 6.1%-13.4%). The mortality of patients undergoing surgery for ICC was higher than that of the general population until year 10, at which time patients alive without tumor recurrence can be considered cured with 99% certainty. Multivariate analysis demonstrated that cure probabilities ranged from 25.8% (time to cure, 9.8 years) in patients with a single, well-differentiated ICC measuring ≤5 cm that was without vascular/periductal invasion and lymph nodes metastases versus <0.1% (time to cure, 12.6 years) among patients with all 6 of these risk factors. A model with which to calculate cure fraction and time to cure was developed.


CONCLUSIONS
The cure model indicated that statistical cure was possible in patients undergoing hepatic resection for ICC. The overall probability of cure was approximately 10% and varied based on several tumor-specific factors. Cancer 2015;121:3998-4006. © 2015 American Cancer Society.
Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Gaya
G
Spolverato
Unit of Hepatobiliary Surgery and Liver Transplantation, University of Padua Medical Center, Padua, Italy.
Alessandro
A
Vitale
Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Alessandro
A
Cucchetti
Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
Irinel
I
Popescu
Hepato-Biliary- Pancreatic and Transplantation Centre, Curry Cabral Hospital, Lisbon, Portugal.
Hugo P
HP
Marques
Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy.
Luca
L
Aldrighetti
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
T Clark
TC
Gamblin
Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Shishir K
SK
Maithel
Department of Surgery, University of Sydney, Sydney, New South Wales, Australia.
Charbel
C
Sandroussi
Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, Virginia.
Todd W
TW
Bauer
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Feng
F
Shen
Department of Surgery, Stanford University, Stanford, California.
George A
GA
Poultsides
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Wallis
JW
Marsh
Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Timothy M
TM
Pawlik
D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged
cure; hepatic resection; intrahepatic cholangiocarcinoma; surgery