The British journal of surgery · 2026
Metastatic lymph node burden and invasive tumour features inform first recurrence patterns after curative-intent resection for intrahepatic cholangiocarcinoma.
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Yuza Kizuki, Chatzipanagiotou Odysseas P, Hobeika Christian, Aucejo Federico, Marques Hugo P, Hugh Tom, Shen Feng, Maithel Shishir K, Groot Koerkamp Bas, Popescu Irinel, Weiss Matthew J, Martel Guillaume, Pulitano Carlo, Poultsides George, Ruzzenente Andrea, Bauer Todd W, Gleisner Ana, Endo Itaru, Pawlik Timothy M
Аннотация
BACKGROUND: Recurrence is a major driver of poor long-term outcomes after curative-intent resection for intrahepatic cholangiocarcinoma (iCCA), yet the association between postoperative pathology, first recurrence patterns, and post-recurrence outcomes remains unclear.
METHODS: Patients who underwent curative-intent resection for iCCA (2000-2023) were identified from an international multi-institutional database. First recurrence patterns were classified as intrahepatic-only, extrahepatic-only, or combined intrahepatic and extrahepatic recurrence. Multivariable analyses assessed associations between postoperative pathological features, first recurrence patterns, post-recurrence survival (PRS), and post-recurrence curative-intent treatment.
RESULTS: Among 1328 patients, 763 patients (57.5%) developed a recurrence; 717 patients had a classifiable first recurrence pattern (381 patients developed intrahepatic-only recurrence, 171 patients developed extrahepatic-only recurrence, and 165 patients developed combined intrahepatic and extrahepatic recurrence). Three or more metastatic lymph nodes (adjusted OR (aOR) 3.47 (95% c.i. 1.56 to 7.72)) and microvascular invasion (aOR 2.49 (95% c.i. 1.61 to 3.85)) were associated with higher odds of combined recurrence compared with intrahepatic-only recurrence, whereas perineural invasion (aOR 2.24 (95% c.i. 1.35 to 3.71)) and the absence of pathological nodal evaluation (aOR 2.04 (95% c.i. 1.24 to 3.36)) were associated with extrahepatic-only recurrence. Compared with intrahepatic-only recurrence, combined recurrence was associated with worse PRS (adjusted HR 1.63 (95% c.i. 1.29 to 2.06)) and lower odds of receiving curative-intent treatment (aOR 0.14 (95% c.i. 0.06 to 0.29)).
CONCLUSION: Pathological nodal burden and invasive tumour features were associated with distinct first recurrence patterns after iCCA resection. Combined recurrence, more common with ≥3 metastatic lymph nodes or microvascular invasion, was associated with worse PRS and lower receipt of curative-intent treatment. Among patients who develop recurrence, pathological prognostic factors available after surgery may help characterize first recurrence patterns and inform risk-adapted postoperative surveillance.
METHODS: Patients who underwent curative-intent resection for iCCA (2000-2023) were identified from an international multi-institutional database. First recurrence patterns were classified as intrahepatic-only, extrahepatic-only, or combined intrahepatic and extrahepatic recurrence. Multivariable analyses assessed associations between postoperative pathological features, first recurrence patterns, post-recurrence survival (PRS), and post-recurrence curative-intent treatment.
RESULTS: Among 1328 patients, 763 patients (57.5%) developed a recurrence; 717 patients had a classifiable first recurrence pattern (381 patients developed intrahepatic-only recurrence, 171 patients developed extrahepatic-only recurrence, and 165 patients developed combined intrahepatic and extrahepatic recurrence). Three or more metastatic lymph nodes (adjusted OR (aOR) 3.47 (95% c.i. 1.56 to 7.72)) and microvascular invasion (aOR 2.49 (95% c.i. 1.61 to 3.85)) were associated with higher odds of combined recurrence compared with intrahepatic-only recurrence, whereas perineural invasion (aOR 2.24 (95% c.i. 1.35 to 3.71)) and the absence of pathological nodal evaluation (aOR 2.04 (95% c.i. 1.24 to 3.36)) were associated with extrahepatic-only recurrence. Compared with intrahepatic-only recurrence, combined recurrence was associated with worse PRS (adjusted HR 1.63 (95% c.i. 1.29 to 2.06)) and lower odds of receiving curative-intent treatment (aOR 0.14 (95% c.i. 0.06 to 0.29)).
CONCLUSION: Pathological nodal burden and invasive tumour features were associated with distinct first recurrence patterns after iCCA resection. Combined recurrence, more common with ≥3 metastatic lymph nodes or microvascular invasion, was associated with worse PRS and lower receipt of curative-intent treatment. Among patients who develop recurrence, pathological prognostic factors available after surgery may help characterize first recurrence patterns and inform risk-adapted postoperative surveillance.