Analysis Of Clinicopathological Characteristics And Prognostic Factors Of Intrahepatic Cholangiocarcinoma

Background and objectiveIntrahepatic cholangiocarcinoma(ICC)is the second most common primary liver tumor,with an increasing incidence in western countries and around the world,accounting for about 10%of primary liver cancer.In most parts of the world,the incidence of ICC increases with age,most of which are between 55 and 75 years old,and the risk of ICC in men is slightly higher than that in women.The concealed onset of ICC and the lack of specific clinical manifestations and ideal tumor markers for early screening and early diagnosis lead to late detection of tumors.Many ICC patients are diagnosed as middle and late stages,and ICC has a high degree of malignancy.The prognosis of the patients is poor,the 5-year overall survival rate is less than 5%,and the median survival time after surgical resection is 36 months.ICC is not sensitive to traditional chemotherapy and radiotherapy.Surgical resection is still the main way for ICC patients to be cured,but the resectability rate is low.Only about 20% of the patients with potential resection have undergone surgical resection,and the postoperative recurrence rate and mortality rate are still high.The risk factors for recurrence and long-term survival of ICC are not completely clear.The purpose of this study was to investigate the factors affecting the recurrence and prognosis of ICC after radical hepatectomy,so as to provide clinical basis for the diagnosis and treatment of ICC.MethodsThe clinical data of 49 patients with intrahepatic cholangiocarcinoma who underwent surgical resection in Zhujiang Hospital of Southern Medical University from January 2011 to December 2018 were analyzed retrospectively.All patients underwent radical resection and microscopic margin negative(R0 resection).Disease-free rate and Survival rate was calculated and survival curve was drawn by Kaplan-Meier method,univariate analysis was performed by Log-rank test,survival differences among groups were compared,and multivariate analysis was performed by Cox regression analysis.ResultsThe median DFS of 49 patients with ICC resected by R0 was 12 months(95%CI 8.361-15.639).The 1-,2-and 3-year diease-free survival rates were 45.6%,29.0%and 16.9%,respectively.And the median OS was 40 months(95%CI 17.937-62.063).The 1 -,3-and 5-year overall survival rates were 69.2%,52.5%and 32.8%,respectively.Univariate analysis showed that preoperative CA199 level(P=0.046),pathological lymph node involvement(P=0.014),maximum tumor diameter(P=0.020),tumor differentiation(P=0.018)and postoperative adjuvant therapy(P=0.030)were risk factors for recurrence after ICC R0 resection.Preoperative CEA level,preoperative CA199 level,liver function grade,lymph node invasion,nerve invasion,tumor number,maximum tumor diameter,TNM stage and tumor differentiation were related to the prognosis of ICC.Multivariate analysis showed that preoperative CA199>40kU/L(HR=3.282,95%CI 1.145-9.405,P=0.027),liver function grade B(HR=4.589,95%CI 1.479-14.235,P=0.008)and poor tumor differentiation(HR=4.679,95%CI 1.757-12.459,P=0.002)were independent risk factors affecting the prognosis of ICC,and had adverse effects on the prognosis of ICC patients after R0 resection.ConclusionPreoperative CA199 level(>40kU/L),liver function grade(grade B)and tumor differentiation(poor differentiation)are independent risk factors affecting the prognosis of ICC.