European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Biologic stratification with tumor burden score and CA19-9 to inform vascular resection in intrahepatic cholangiocarcinoma.
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Yuza Kizuki, Kawashima Jun, Chatzipanagiotou Odysseas P, Hobeika Christian, Aucejo Federico, Marques Hugo P, Hugh Tom, Shen Feng, Maithel Shishir K, Koerkamp Bas Groot, Popescu Irinel, Kitago Minoru, Weiss Matthew J, Martel Guillaume, Pulitano Carlo, Poultsides George, Ruzzenente Andrea, Bauer Todd W, Gleisner Ana, Endo Itaru, Pawlik Timothy M
Аннотация
BACKGROUND: The prognostic impact of vascular resection in intrahepatic cholangiocarcinoma (iCCA) remains uncertain, particularly in the context of advanced disease requiring complex surgery. This study evaluated the association between vascular resection and long-term survival and examined how tumor biology, assessed with tumor burden score (TBS) and CA19-9, influenced outcomes.
METHODS: Patients who underwent upfront curative-intent hepatectomy for iCCA were identified from an international multi-institutional database. Multivariable Cox regression assessed overall (OS) and recurrence-free survival (RFS). Among patients undergoing vascular resection, biologic heterogeneity was explored using optimized TBS and CA19-9 cutoffs to define biologic risk subgroups.
RESULTS: Among 1757 patients, 9.7% (n = 171) required major vascular resection. These patients were more likely to have bilateral tumors (29.2% vs. 21.3%), lymph node metastasis (33.9% vs. 24.8%), and T3/T4 tumors (57.3% vs. 27.6%) (all p < 0.05). Vascular resection was not an independent predictor of OS (aHR 1.11, 95% CI 0.82-1.51) or RFS (HR 1.02, 95% CI 0.81-1.27). Within the vascular resection cohort, higher TBS (aHR 1.11, 95% CI 1.03-1.19) and higher CA19-9 (log-transformed; aHR 1.16, 95% CI 1.02-1.32) were independently associated with worse OS. Five-year survival decreased stepwise from favorable to unfavorable biologic profiles. Patients with favorable biology demonstrated survival comparable to individuals undergoing hepatectomy without vascular resection.
CONCLUSION: Major vascular resection did not independently worsen prognosis after iCCA hepatectomy. Instead, tumor biology-captured by TBS and CA19-9-was strongly associated with long-term outcomes, highlighting the importance of biologic risk stratification when considering vascular resection.
METHODS: Patients who underwent upfront curative-intent hepatectomy for iCCA were identified from an international multi-institutional database. Multivariable Cox regression assessed overall (OS) and recurrence-free survival (RFS). Among patients undergoing vascular resection, biologic heterogeneity was explored using optimized TBS and CA19-9 cutoffs to define biologic risk subgroups.
RESULTS: Among 1757 patients, 9.7% (n = 171) required major vascular resection. These patients were more likely to have bilateral tumors (29.2% vs. 21.3%), lymph node metastasis (33.9% vs. 24.8%), and T3/T4 tumors (57.3% vs. 27.6%) (all p < 0.05). Vascular resection was not an independent predictor of OS (aHR 1.11, 95% CI 0.82-1.51) or RFS (HR 1.02, 95% CI 0.81-1.27). Within the vascular resection cohort, higher TBS (aHR 1.11, 95% CI 1.03-1.19) and higher CA19-9 (log-transformed; aHR 1.16, 95% CI 1.02-1.32) were independently associated with worse OS. Five-year survival decreased stepwise from favorable to unfavorable biologic profiles. Patients with favorable biology demonstrated survival comparable to individuals undergoing hepatectomy without vascular resection.
CONCLUSION: Major vascular resection did not independently worsen prognosis after iCCA hepatectomy. Instead, tumor biology-captured by TBS and CA19-9-was strongly associated with long-term outcomes, highlighting the importance of biologic risk stratification when considering vascular resection.