Long-term outcome and prognostic factors of intrahepatic cholangiocarcinoma.

Background: The management of intrahepatic cholangiocarcinoma (ICC) remains a challenge due to poor prognosis. The aim of this study was to summarize the surgical management experience in recent 10 years and to identify the influencing factors related to outcome of patients with ICC in a single hepatobiliary center.

Methods: From January 1995 to June 2005, 136 patients with ICC undergoing surgery were reviewed retrospectively. Survival rates of patients were calculated using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were identified by the Cox regression model.

Results: Seventy-nine of 136 patients underwent resection, and 65 of 79 patients were curative (R0). The surgical mortality was 2.2%. The 1-, 3- and 5-year survival rates of patients undergoing R0 resection were 72.1%, 35.6% and 20.1% respectively, which were significantly longer than those who underwent palliative resection and exploration, respectively (P < 0.01). At stage IV of the disease, 10 patients who underwent aggressive curative resection achieved a better median survival than those (n = 12) without resection (14 months vs 3 months, P < 0.001). The independent prognostic factors of the whole group were TNM stage (OR, 2.013, P = 0.008) and curative resection (OR, 2.957, P = 0.003). Higher TNM stage (OR, 1.894, P = 0.004) and lymph node metastasis (OR, 4.248, P = 0.005) linked to poor prognosis after R0 resection. For patients without lymph node metastasis, the median survival of those who underwent regional lymphadenectomy was comparable with those who did not (18 months vs 22 months, P = 0.817).

Conclusions: R0 resection is mandatory for ICC patient to achieve long-term survival. Aggressive resection benefits for selected patients with local advanced disease. Higher TNM stage and lymph node metastasis were poor prognostic factors for ICC patients after R0 resection.