Intrahepatic cholangiocarcinoma: Rising frequency, improved survival, and determinants of outcome after resection

Itaru Endo, Mithat Gonen, Adam C. Yopp, Kimberly M. Dalal, Qin Zhou, David Klimstra, Michael D'Angelica, Ronald P. Dematteo, Yuman Fong, Lawrence Schwartz, Nancy Kemeny, Eileen O'Reilly, Ghassan K. Abou-Alfa, Hiroshi Shimada, Leslie H. Blumgart, William R. Jarnagin

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Abstract

BACKGROUND:: Despite data suggesting a rising worldwide incidence, intrahepatic cholangiocarcinoma (IHC) remains an uncommon disease. This study analyzes changes in IHC frequency, demographics, and treatment outcome in a consecutive and single institutional cohort. METHODS:: Consecutive patients with confirmed IHC seen and treated over a 16-year period were included. The trend in IHC frequency over the study period was compared with that of hilar cholangiocarcinoma patients (HCCA) seen during the same time. Demographics and patient disposition, histopathologic, treatment, recurrence, and survival data were analyzed; changes in these variables over time were assessed. RESULTS:: From December 1990 through July 2006, 594 patients were evaluated (IHC = 270, HCCA = 324). Over the study period, the average annual increase in new IHC patients was 14.2% (P < 0.001). Relative to HCCA, the proportional increase in IHC was nearly 3-fold, and new IHC patients have outnumbered those with HCCA by 2:1 over the last 3 years. Conditions associated with IHC were rarely seen, with only 7 patients having a history of sclerosing cholangitis and/or inflammatory bowel disease and none with hepatolithiasis or biliary parasitic disease; however, heavy tobacco use (27%) and diabetes mellitus (16.4%) were particularly prevalent. The majority of patients were not candidates for resection, most commonly because of advanced hepatic disease. After resection (n = 82), median disease-specific survival was 36 months; recurrence was observed in 62.2% of patients at a median follow-up of 26 months, with the liver remnant involved most frequently (62.7%). Multiple hepatic tumors (P < 0.001), regional nodal involvement (P = 0.012), and large tumor size (P = 0.016) independently predicted poor recurrence-free survival. Most patients (n = 115, 73.7%) with unresectable disease were treated with chemotherapy, either systemic alone (n = 75) or combined with regional hepatic arterial floxuridine (FUDR) (n = 28). Compared with the first 10 years of the study (1990-2000), the last 6 years saw an overall improvement in disease-specific survival for all patients (22 vs. 12 months, P = 0.002), which was particularly notable for patients with unresectable disease (15 vs. 6 months, P = 0.003). CONCLUSIONS:: At Memorial Sloan-Kettering Cancer Center, IHC incidence has increased dramatically in the last 16 years. Resection offers the best opportunity for long-term survival but is possible in the minority, and patients with large, node-positive or multifocal IHC seem to derive little benefit. Establishing and maintaining control of the intrahepatic disease remains the biggest problem for all IHC patients. The recent increase in survival seems largely because of improved nonoperative therapy for unresectable disease.

Original languageEnglish (US)
Pages (from-to)84-96
Number of pages13
JournalAnnals of Surgery
Volume248
Issue number1
DOIs
StatePublished - Jul 2008

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Cholangiocarcinoma
Survival
Klatskin Tumor
Liver
Recurrence
Demography
Floxuridine
Neoplasms
Sclerosing Cholangitis
Parasitic Diseases
Incidence
Tobacco Use

ASJC Scopus subject areas

  • Surgery

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Intrahepatic cholangiocarcinoma : Rising frequency, improved survival, and determinants of outcome after resection. / Endo, Itaru; Gonen, Mithat; Yopp, Adam C.; Dalal, Kimberly M.; Zhou, Qin; Klimstra, David; D'Angelica, Michael; Dematteo, Ronald P.; Fong, Yuman; Schwartz, Lawrence; Kemeny, Nancy; O'Reilly, Eileen; Abou-Alfa, Ghassan K.; Shimada, Hiroshi; Blumgart, Leslie H.; Jarnagin, William R.

In: Annals of Surgery, Vol. 248, No. 1, 07.2008, p. 84-96.

Research output: Contribution to journalArticle

Endo, I, Gonen, M, Yopp, AC, Dalal, KM, Zhou, Q, Klimstra, D, D'Angelica, M, Dematteo, RP, Fong, Y, Schwartz, L, Kemeny, N, O'Reilly, E, Abou-Alfa, GK, Shimada, H, Blumgart, LH & Jarnagin, WR 2008, 'Intrahepatic cholangiocarcinoma: Rising frequency, improved survival, and determinants of outcome after resection', Annals of Surgery, vol. 248, no. 1, pp. 84-96. https://doi.org/10.1097/SLA.0b013e318176c4d3
Endo, Itaru ; Gonen, Mithat ; Yopp, Adam C. ; Dalal, Kimberly M. ; Zhou, Qin ; Klimstra, David ; D'Angelica, Michael ; Dematteo, Ronald P. ; Fong, Yuman ; Schwartz, Lawrence ; Kemeny, Nancy ; O'Reilly, Eileen ; Abou-Alfa, Ghassan K. ; Shimada, Hiroshi ; Blumgart, Leslie H. ; Jarnagin, William R. / Intrahepatic cholangiocarcinoma : Rising frequency, improved survival, and determinants of outcome after resection. In: Annals of Surgery. 2008 ; Vol. 248, No. 1. pp. 84-96.
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abstract = "BACKGROUND:: Despite data suggesting a rising worldwide incidence, intrahepatic cholangiocarcinoma (IHC) remains an uncommon disease. This study analyzes changes in IHC frequency, demographics, and treatment outcome in a consecutive and single institutional cohort. METHODS:: Consecutive patients with confirmed IHC seen and treated over a 16-year period were included. The trend in IHC frequency over the study period was compared with that of hilar cholangiocarcinoma patients (HCCA) seen during the same time. Demographics and patient disposition, histopathologic, treatment, recurrence, and survival data were analyzed; changes in these variables over time were assessed. RESULTS:: From December 1990 through July 2006, 594 patients were evaluated (IHC = 270, HCCA = 324). Over the study period, the average annual increase in new IHC patients was 14.2{\%} (P < 0.001). Relative to HCCA, the proportional increase in IHC was nearly 3-fold, and new IHC patients have outnumbered those with HCCA by 2:1 over the last 3 years. Conditions associated with IHC were rarely seen, with only 7 patients having a history of sclerosing cholangitis and/or inflammatory bowel disease and none with hepatolithiasis or biliary parasitic disease; however, heavy tobacco use (27{\%}) and diabetes mellitus (16.4{\%}) were particularly prevalent. The majority of patients were not candidates for resection, most commonly because of advanced hepatic disease. After resection (n = 82), median disease-specific survival was 36 months; recurrence was observed in 62.2{\%} of patients at a median follow-up of 26 months, with the liver remnant involved most frequently (62.7{\%}). Multiple hepatic tumors (P < 0.001), regional nodal involvement (P = 0.012), and large tumor size (P = 0.016) independently predicted poor recurrence-free survival. Most patients (n = 115, 73.7{\%}) with unresectable disease were treated with chemotherapy, either systemic alone (n = 75) or combined with regional hepatic arterial floxuridine (FUDR) (n = 28). Compared with the first 10 years of the study (1990-2000), the last 6 years saw an overall improvement in disease-specific survival for all patients (22 vs. 12 months, P = 0.002), which was particularly notable for patients with unresectable disease (15 vs. 6 months, P = 0.003). CONCLUSIONS:: At Memorial Sloan-Kettering Cancer Center, IHC incidence has increased dramatically in the last 16 years. Resection offers the best opportunity for long-term survival but is possible in the minority, and patients with large, node-positive or multifocal IHC seem to derive little benefit. Establishing and maintaining control of the intrahepatic disease remains the biggest problem for all IHC patients. The recent increase in survival seems largely because of improved nonoperative therapy for unresectable disease.",
author = "Itaru Endo and Mithat Gonen and Yopp, {Adam C.} and Dalal, {Kimberly M.} and Qin Zhou and David Klimstra and Michael D'Angelica and Dematteo, {Ronald P.} and Yuman Fong and Lawrence Schwartz and Nancy Kemeny and Eileen O'Reilly and Abou-Alfa, {Ghassan K.} and Hiroshi Shimada and Blumgart, {Leslie H.} and Jarnagin, {William R.}",
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TY - JOUR

T1 - Intrahepatic cholangiocarcinoma

T2 - Rising frequency, improved survival, and determinants of outcome after resection

AU - Endo, Itaru

AU - Gonen, Mithat

AU - Yopp, Adam C.

AU - Dalal, Kimberly M.

AU - Zhou, Qin

AU - Klimstra, David

AU - D'Angelica, Michael

AU - Dematteo, Ronald P.

AU - Fong, Yuman

AU - Schwartz, Lawrence

AU - Kemeny, Nancy

AU - O'Reilly, Eileen

AU - Abou-Alfa, Ghassan K.

AU - Shimada, Hiroshi

AU - Blumgart, Leslie H.

AU - Jarnagin, William R.

PY - 2008/7

Y1 - 2008/7

N2 - BACKGROUND:: Despite data suggesting a rising worldwide incidence, intrahepatic cholangiocarcinoma (IHC) remains an uncommon disease. This study analyzes changes in IHC frequency, demographics, and treatment outcome in a consecutive and single institutional cohort. METHODS:: Consecutive patients with confirmed IHC seen and treated over a 16-year period were included. The trend in IHC frequency over the study period was compared with that of hilar cholangiocarcinoma patients (HCCA) seen during the same time. Demographics and patient disposition, histopathologic, treatment, recurrence, and survival data were analyzed; changes in these variables over time were assessed. RESULTS:: From December 1990 through July 2006, 594 patients were evaluated (IHC = 270, HCCA = 324). Over the study period, the average annual increase in new IHC patients was 14.2% (P < 0.001). Relative to HCCA, the proportional increase in IHC was nearly 3-fold, and new IHC patients have outnumbered those with HCCA by 2:1 over the last 3 years. Conditions associated with IHC were rarely seen, with only 7 patients having a history of sclerosing cholangitis and/or inflammatory bowel disease and none with hepatolithiasis or biliary parasitic disease; however, heavy tobacco use (27%) and diabetes mellitus (16.4%) were particularly prevalent. The majority of patients were not candidates for resection, most commonly because of advanced hepatic disease. After resection (n = 82), median disease-specific survival was 36 months; recurrence was observed in 62.2% of patients at a median follow-up of 26 months, with the liver remnant involved most frequently (62.7%). Multiple hepatic tumors (P < 0.001), regional nodal involvement (P = 0.012), and large tumor size (P = 0.016) independently predicted poor recurrence-free survival. Most patients (n = 115, 73.7%) with unresectable disease were treated with chemotherapy, either systemic alone (n = 75) or combined with regional hepatic arterial floxuridine (FUDR) (n = 28). Compared with the first 10 years of the study (1990-2000), the last 6 years saw an overall improvement in disease-specific survival for all patients (22 vs. 12 months, P = 0.002), which was particularly notable for patients with unresectable disease (15 vs. 6 months, P = 0.003). CONCLUSIONS:: At Memorial Sloan-Kettering Cancer Center, IHC incidence has increased dramatically in the last 16 years. Resection offers the best opportunity for long-term survival but is possible in the minority, and patients with large, node-positive or multifocal IHC seem to derive little benefit. Establishing and maintaining control of the intrahepatic disease remains the biggest problem for all IHC patients. The recent increase in survival seems largely because of improved nonoperative therapy for unresectable disease.

AB - BACKGROUND:: Despite data suggesting a rising worldwide incidence, intrahepatic cholangiocarcinoma (IHC) remains an uncommon disease. This study analyzes changes in IHC frequency, demographics, and treatment outcome in a consecutive and single institutional cohort. METHODS:: Consecutive patients with confirmed IHC seen and treated over a 16-year period were included. The trend in IHC frequency over the study period was compared with that of hilar cholangiocarcinoma patients (HCCA) seen during the same time. Demographics and patient disposition, histopathologic, treatment, recurrence, and survival data were analyzed; changes in these variables over time were assessed. RESULTS:: From December 1990 through July 2006, 594 patients were evaluated (IHC = 270, HCCA = 324). Over the study period, the average annual increase in new IHC patients was 14.2% (P < 0.001). Relative to HCCA, the proportional increase in IHC was nearly 3-fold, and new IHC patients have outnumbered those with HCCA by 2:1 over the last 3 years. Conditions associated with IHC were rarely seen, with only 7 patients having a history of sclerosing cholangitis and/or inflammatory bowel disease and none with hepatolithiasis or biliary parasitic disease; however, heavy tobacco use (27%) and diabetes mellitus (16.4%) were particularly prevalent. The majority of patients were not candidates for resection, most commonly because of advanced hepatic disease. After resection (n = 82), median disease-specific survival was 36 months; recurrence was observed in 62.2% of patients at a median follow-up of 26 months, with the liver remnant involved most frequently (62.7%). Multiple hepatic tumors (P < 0.001), regional nodal involvement (P = 0.012), and large tumor size (P = 0.016) independently predicted poor recurrence-free survival. Most patients (n = 115, 73.7%) with unresectable disease were treated with chemotherapy, either systemic alone (n = 75) or combined with regional hepatic arterial floxuridine (FUDR) (n = 28). Compared with the first 10 years of the study (1990-2000), the last 6 years saw an overall improvement in disease-specific survival for all patients (22 vs. 12 months, P = 0.002), which was particularly notable for patients with unresectable disease (15 vs. 6 months, P = 0.003). CONCLUSIONS:: At Memorial Sloan-Kettering Cancer Center, IHC incidence has increased dramatically in the last 16 years. Resection offers the best opportunity for long-term survival but is possible in the minority, and patients with large, node-positive or multifocal IHC seem to derive little benefit. Establishing and maintaining control of the intrahepatic disease remains the biggest problem for all IHC patients. The recent increase in survival seems largely because of improved nonoperative therapy for unresectable disease.

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