Abstract: Objective:To identify the prognostic factors for patients with intrahepatic cholangiocarcinoma.
Methods:The clinical data of 99 patients with intrahepatic cholangiocarcinoma who received surgical treatment at the Cancer Hospital of Tianjin Medical University from January 2000 to January 2010 were analyzed retrospectively. Lymph nodes at the hepatic portal and group 12, 13 and 8 lymph nodes were resected. The range of hepatectomy was decided according to the size, location, number of tumor and the hepatic function. Patients were followed up every month within the first 6 months after operation, every 3 months at 6 months later, and they were followed up every half year at 2 years later. Patients who were suspected as with tumor recurrence or progression were followed up every month. All the patients were followed up till death or March of 2013. The survival was analyzed using the Log rank test, and multivariate analysis was done using the COX regression model. Results:Forty patients received hemi hepatectomy, 27 received extended hemi hepatectomy, 20 received segmentectomy, and 12 received hemi hepatectomy+wedge resection. All the patients were followed up and the median time of follow up was 33 months (range 21.1 -44.9 months). The 1 , 3 , 5 year recurrence free survival rates and total survival rates of the 99 patients were 64.6%, 29.2%, 22.7% and 78.8%, 46.4% and 30.3%, respectively. The results of univariate analysis showed that hepatitis B or C virus infection, preoperative CA19 -9 level, TNM staging, lymph node metastasis, microvascular invasion, number of nodules and R0 resection were risk factors influencing the recurrence free survival time (Log rank value=5.048, 5.982, 20.128, 13.148, 29.632, 32.488, 50.574, P<0.05). The peroperative CA19 -9 level, TNM staging, lymph node metastasis, microvascular invasion, number of nodules and R0 resection were risk factors influencing the total survival rate (Log rank value=4.302, 17.267, 11.756, 23.840, 36.411, 47.126, P<0.05). There were significant differences in the recurrence free survival time and total survival time between patients in different TNM stages (20 patients in stage Ⅰ, 44 in stage Ⅱ, 8 in stage Ⅲ and 27 in stage Ⅳ) (Log rank value=20.128, 17.267, P<0.05). There were significant difference in the recurrence free survival time between patients in stage Ⅰ and Ⅲ, patients in stage Ⅰ and Ⅳ, and between patients in stage Ⅱ and Ⅳ (Log rank value=10.807, 19.368, 6.347, P<0.05). There were significant difference in the total survival time between patients in stage Ⅰ and Ⅱ, patients in stage Ⅰ and Ⅲ, patients in stage Ⅰ and Ⅳ and between patients in stage Ⅱ and Ⅳ (Log rank value=6.119, 4.015, 16.282, 4.929, P<0.05). There was no significant difference in the survival time between patients in other TNM stages (P>0.05). The results of multivariate analysis showed that TNM stage Ⅲ and Ⅳ, microvascular invasion, multiple nodules and R0 resection were independent risk factors influencing the recurrence free survival time (RR=1.413, 3.073, 2.737, 3.916, 95% confidence interval: 1.119 -1.784, 1.837 -5.140, 1.338 -4.207, 1.849 -8.291, P<0.05); lymph node metastasis, microvascular invasion, multiple tumors and R0 resection were the independent risk factors influencing the total survival time (RR=2.025, 2.948, 0.327, 3.494, 95% confidence interval: 1.215 -3.374, 1.774 -4.900, 0.183 -0.583, 1.670 -7.310, P<0.05).
Conclusions:TNM stage Ⅲ and Ⅳ, lymph node metastasis, microvascular invasion, multiple nodules, non R0 resection shorten the recurrence free survival time and total survival time of patients who received surgical resection for intrahepatic cholangiocarcinoma, and they are the main factors influencing the prognosis. R0 resection could improve the survival of patients with intrahepatic cholangiocarcinoma.