Outcomes And Prognostic Factors Of Surgical Resection Of Hepatolithiasis-associated Intrahepatic Cholangiocarcinoma

BackgroundIntrahepatic cholangiocarcinoma(ICC)is a malignancy that arises from the epithelial cells of the biliary system and is the second most common primary hepatic malignancy after hepatocellular carcinoma(HCC),and accounts for 10-15% of primary liver cancers.The incidence of ICC has increased during the past years significantly.Hepatolithiasis is a benign disease,and the incidence of hepatolithiasis is high in Southeast Asian,such as China,Hong Kong,South Korea,and Japan.It is also a known risk factor for intrahepatic cholangiocarcinoma(ICC).The incidence of hepatolithiasisassociated intrahepatic cholangiocarcinoma(HICC)is not low in our country,As the diagnosis of hepatolithiasis-associated intrahepatic cholangiocarcinoma often tend to be late,the patients often result in poor prognosis.ObjectiveTo analyzed Long-term outcomes prognostic factor in hepatolithiasis-associated intrahepatic cholangiocarcinoma patients following hepatectomy,aiming to provide some help to the clinic treatment of hepatolithiasis-associated intrahepatic cholangiocarcinoma patients.MethodThis study retrospectively collected clinical data of 501 patients with ICC confirmed by pathology from January 2012 to January 2015 in the Hunan Provincial People's Hospital.Of the 501 patients,63 patients were HICC.Clinical data collected include:Age,Gender,History of drinking,Smoking history,The duration of hepatolithiasis,serum albumin(ALB),serum total bilirubin(TBil),serum direct bilirubin(DBil),serum alanine aminotransferase(ALT),serum aspertate aminotransferase(AST),serum carbohydrate antigen 19-9(CA19-9),serum carcinoembryonic antigen(CEA),serum alpha-fetoprotein(AFP),serum cancer antigen 125(CA125),tumor differentiation,portal vein tumor thrombus,Vascular invasion.The follow-up of outpatient examination and telephone interview was performed to detect patients' survival up to December 2017.Survival curves were drawn by the Kaplan-Meier method and univariate analyses were done using the Logrank test,and multivariate analysis was done by using the Cox proportional hazard model.A P value<0.05 Was considered statistically significant.Statistical analyses were performed using SPSS version 18.ResultsAmong the 63 study patients,61 were followed up for 5 to 66 months,with a mediam follow-up time of 28 months,and the mediam survival time is 16 months.The overall cumulative survival rates were 79.4%,46.0%,25.3% at 1,3,and 5 years,respectively.On univariate analysis,serum CA19-9 and tumor differentiation were related factors affecting prognosis of HICC(P<0.05).Multivariable analysis showed that serum CA19-9>35U/ml,poor tumor differentiation,vascular invasion and serum ALT>50U/L were the independent risk factors affecting the poor prognosis of patients with HICC(P<0.05).Conclusion1.The overall survival of hepatolithiasis-associated intrahepatic cholangiocarcinoma patients following hepatectomy was short.2.Four risk factors as follow:serum CA199>35U/ml,poor differentiation,vascular invasion and serum ALT>50U/L were found to be associated with poor overall survival.