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. Conclusion Future clinical trials could include certain molecular and pathologic factors to assist in determining the necessity and type of adjuvant therapy. J. Surg. Oncol. 2014 109:98-103. © 2013 Wiley Periodicals, Inc. © 2013 Wiley Periodicals, Inc.