The Clinicopathological Features And Prognosis Of Hepatitis B Virus Associated Intrahepatic Cholangiocarcinoma

Background: Recent efforts suggest an etiologic role of hepatitis B virus (HBV) infectionin intrahepatic cholangiocarcinoma (ICC). These findings also suggest that hepatitis virus-associated ICC share common disease processes with hepatocellular carcinoma (HCC),and should be distinguished from those without hepatitis virus infection. However, untilnow there has been no evidence that hepatitis-associated ICC are different from thosearising from patients without hepatotropic virus infection. The purpose of this study was toclarify the clinicopathologic characteristics and surgical outcomes of patients with HBV-associated ICC.Methods: All patients with chronic HBV infection were identified from a database ofpatients with ICC that underwent surgical resection between January1,2005, andDecember31,2006. Their clinicopathologic and survival characteristics were comparedwith ICC patients without chronic HBV infection. Comparison between groups wasexamined with Student’s t-tests, Chi-square test or Fisher’s exact test. The overall survivalwas calculated using the Kaplan-Meier method. The log-rank test was used to assessdifferences.Results: The age of the HBV-associated ICC patients tend to be younger than that of ICCpatients without chronic HBV infection. HBV-associated ICC patients tend to have higherabnormal a-fetoprotein (AFP) levels and lower abnormal serum carbohydrate antigen19-9(CA19-9), r-glutamyltransferase (r-GT), and alkaline phosphatase (ALP) levels. Thepathologic features of the resected specimens revealed that HBV-associated ICC patientstended to be of the mass-forming type, have a lower prevalence of lymphatic involvementand poorer tumor differentiation, and a higher prevalence of capsule formation and livercirrhosis. Patients with HBV-associated ICC had a significantly better survival thanpatients without chronic HBV infection. Multivariate analysis revealed that liver cirrhosis(hazard ratio [HR]1.875,95%CI1.197-3.278, P=0.008) and multiple tumors (HR2.653,95%CI1.562-4.508, P<0.001) were independent prognostic factors on survival. Livercirrhosis (HR1.919, P=0.012), vascular invasion (HR3.779, P=0.02), and advancedTNM stage (stage III or IV)(HR2.027, P <0.001) were independent prognostic factors fordisease-free survival. Conclusions: The clinicopathological features of HBV-associated ICC patients showedsignificant differences from ICC patients without HBV infection. The age of the HBV-associated ICC patients tend to be younger and have higher abnormal AFP levels.Thesetumors are characterized by the mass-forming growth pattern and appeared to have a morefavorable prognosis. The cumulative1-,3-, and5-year survival rates of HBV-associatedICC patients were60%,18%, and13%, respectively. Liver cirrhosis, vascular invasion,and advanced TNM stage (stage III or IV) were independent prognostic factors for disease-free survival. Liver cirrhosis and multiple tumors were independent prognostic factors onsurvival of HBV-associated ICC patients.