Although surgery offers the best chance of a potential cure for patients with localized, resectable intrahepatic cholangiocarcinoma (ICC), prognosis of patients remains dismal largely because of a high incidence of recurrence. A new tool helps to predict which patients will develop very early recurrence (VER) (ie, recurrence within 6 months) after resection for intrahepatic cholangiocarcinoma and are therefore the best candidates for neoadjuvant chemotherapy.
In this multi-institutional cohort study, 196 out of 880 patients (22.3%) developed VER following resection. The 5-year overall survival among patients with and without VER was 8.9% vs 49.8%, respectively (P < .001). A preoperative model was able to stratify patients relative to the risk for VER: low risk (6-month recurrence-free survival [RFS], 87.7%), intermediate risk (6-month RFS, 72.3%), and high risk (6-month RFS, 49.5%) (log-rank P < .001).
The postoperative model similarly identified cohorts of patients based on probability for VER: low risk (6-month RFS, 90.0%), intermediate risk (6-month RFS, 73.1%), and high risk (6-month RFS, 48.5%) (log-rank, P < .001). The calibration and predictive accuracy of the pre- and postoperative models were good in the training (C index: preoperative, 0.710; postoperative, 0.722) as well as the internal (C index: preoperative, 0.715; postoperative, 0.728) and external (C index: postoperative, 0.672) validation data sets.
In conclusion, this new tool was developed to help clinicians predict the chance of VER after curative-intent resection for ICC. The tool performed well on internal and external validation and may help clinicians in the preoperative selection of patients for neoadjuvant therapy. Furthermore, the tool could help during the postoperative period to inform surveillance strategies.
Tsilimigras DI, Sahara K, Wu L et al. Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches. JAMA Surg. 2020 Jul 8;e201973.