Clinicopathological Characteristics And Prognosis Of Hepatolithiasis-associated Intrahepatic Cholangiocarcinoma

Objective: To investigate clinicopathological characteristics and prognosis of hepatolithiasis-associated intrahepatic cholangiocarcinoma(HL-iCCA).Methods: The clinical data of patients with intrahepatic cholangiocarcinoma(i CCA)underwent surgery in our hospital from January 2005 to December 2017 were retrospectively analyzed.The eligible subjects were enrolled according the inclusion and exclusion criteria and divided into two groups: HL-iCCA group(group A)and non-HL-iCCA group(group B).Then,the clinicopathological and prognostic differences between these two groups were compared.Results:(1)81 patients enrolled this study including 53 of the group A and 28 of the group B.The most common symptoms were abdominal pain(84.0%,68/81),chills and fever(18.5%,15/81),nausea and vomiting(18.5%,15/81),and jaundice(14.8%,12/81).The present of the first three symptoms were more common in group A than group B(P<0.05).There was no significant difference in the laboratory data between the two groups(P>0.05).The diagnostic accuracy of imaging examination(BUS,CT)in group B was significantly higher than those in group A(87.0%,92.0%vs 62.2%,70.8%,P<0.05).(2)Among these cases,38 patients underwent major hepatectomy(25 in group A and 13 in group B),and 43 patients underwent minor hepatectomy(28 in group A and 15 in group B).Fifty-seven patients underwent lymphadenectomy(38 in group A and 19 in group B).Sixty-three patients achieved R0 resection(42 in group A and 21 in group B).The morbidity and mortality were20.8% and 1.9% in group A,10.7% and 0 in group B.There was no statistically significant difference in the operative time,extent of hepatectomy,lymphadenectomy,R0 resection,morbidity and mortality between the two groups(all P>0.05).(3)The frequency of lymph node metastases was 34.2%(13/38)in group A and 21.1%(4/19)in group B(P>0.05).The incidence of lymph vessel tumor emboli in group A was significantly higher than that in group B(37.7% vs 14.3%,P=0.028),as well as the incidence of perineural invasion(32.1% vs 10.7%,P=0.034).There wasno statistically significant difference in the tumor size,morphological type,histologic differentiation,and TNM stage between the two groups(all P>0.05).(4)72 patients achieved survival data,and the 1-,3-,5-year cumulative survival rates were 86.8%,44.9%,and 17.1%,respectively.The median survival time was 35 months.The 1-,3-,5-year survival rates of patients in group B were significantly superior than those of group A(91.4%,62.1%,24.8% vs 84.3%,35.7%,11.9%,P=0.017).The median survival time of patients in group A and B was 29 and 41 months,respectively.Among these patients achieved survival data,the 1-,3-,5-year survival rates of patients with lymphadenectomy were significantly superior than those without lymphadenectomy(P=0.042).In group A,the 1-,3-,5-year survival rates of patients with lymphadenectomy were also significantly superior than those without lymphadenectomy(P=0.047).Meanwhile,the 1-,3-,5-year survival rates of pN0 subgroup were significantly superior than those of pN1 and pNx subgroup(pN0 vs pN1,P=0.006;pN0 vs pNx,P=0.044).Conclusion: Patients of HL-iCCA are more likely to present with clinical symptoms,while have a lower diagnostic accuracy of imaging examinations of BUS and CT.HL-iCCA is prone to lymph vessel tumor emboli and perineural invasion,and its prognosis is worse than non-HL-iCCA.Radical resection is the most effective therapy for iCCA,and regional lymphadenectomy is helpful in tumor staging and improving the prognosis.