Risk factors of very early recurrence of intrahepatic cholangiocarcinoma after surgery

doi:10.3877/cma.j.issn.2095-3232.2025012

Abstract

Abstract:

Objective

To investigate the risk factors of very early recurrence (VER) in patients with intrahepatic cholangiocarcinoma (ICC) after surgery.

Methods

Clinicals data of 445 ICC patients undergoing surgery in Mengchao Hepatobiliary Hospital of Fujian Medical University,Oriental Hepatobiliary Surgery Hospital of Naval Medical University, Zhongda Hospital Affiliated to Southeast University, the Second Affiliated Hospital of Zhejiang University School of Medicine, the First Affiliated Hospital of Army Medical University, Peking Union Medical College Cancer Hospital of Chinese Academy of Medical Sciences, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Beijing Friendship Hospital Affiliated to Capital Medical University, West China Hospital of Sichuan University, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuanwu Hospital of Capital Medical University, Affiliated Hospital of North Sichuan Medical College and Beijing Tiantan Hospital Affiliated to Capital Medical University from December 2011 to December 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 270 patients were male and 175 female, aged from 23 to 88 years, with a median age of 57 years.The tumor diameter was ranged from 1.1 to 20.4 cm, with a median diameter of 6.0 cm.According to the recurrence of ICC within postoperative 6 months, they were divided into the VER group (n=328) and non-VER group (n=117).Postoperative follow-up data were assessed by univariate and multivariate Logistic regression analyses.Survival analysis was conducted by using Kaplan-Meier method and Log-rank test.

Results

Multivariate Logistic regression analysis showed that gender (OR=0.51, 95%CI: 0.32-0.84), age(OR=0.97, 95%CI: 0.95-0.99), tumor number (OR=1.28, 95%CI: 1.06-1.54), pathological type (OR=0.40,95%CI: 0.16-0.99) and maximum tumor diameter (OR=1.10, 95%CI: 1.02-1.17) were the independent risk factors of VER in ICC patients after surgery (all P＜0.05).Postoperative follow-up was ranged from 6 to 73 months, with a median follow-up time of 21 months.During postoperative follow-up, 236 patients died and 209 cases survived.The 1-, 3- and 5-year survival rates in the VER and non-VER groups were 60.71%, 7.14%, 0 and 89.90%, 54.40% and 25.30%, respectively, and the differences were statistically significant (χ²=88.844, P＜0.001).

Conclusions

Pathological type, tumor number and maximum tumor diameter are the independent risk factors of VER in ICC patients after surgery.ICC patients with VER obtain poor prognosis.

Key words: Intrahepatic cholangiocarcinoma, Liver neoplasms, Recurrence, Very early stage, Risk factors

Chengshu Yu, Hongzhi Liu, Kecan Lin, Qizhu Lin, Tingfeng Huang, Weiping Zhou, Zhangjun Cheng, Jianying Lou, Shuguo Zheng, Xinyu Bi, Jianming Wang, Wei Guo, Fuyu Li, Jian Wang, Yamin Zheng, Jingdong Li, Shi Cheng, Yongyi Zeng. Risk factors of very early recurrence of intrahepatic cholangiocarcinoma after surgery[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(01): 53-59.

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References 30

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指标	非VER组	VER组	统计值	P值
年龄[岁，M（Q₁，Q₃）]	59（51，65）	55（46，61）	Z=-3.402	0.001
性别（例，男/女）	188/140	82/35	χ²=5.369	0.021
肝胆肿瘤家族史（例）	27	11	χ²=0.038	0.845
乙肝史（例）	120	47	χ²=0.332	0.564
肝切除史（例）	12	0	χ²=3.115	0.078
Child-Pugh A级（例）	206	69	χ²=0.386	0.534
术前新辅助治疗	17	10	χ²=2.193	0.334
淋巴结转移（例）	56	11	χ²=3.391	0.066
腹腔镜手术（例）	300	113	χ²=2.661	0.103
淋巴结清扫（例）	109	41	χ²=0.059	0.809
肿块型（例）	223	84	χ²=0.420	0.517
腺癌（例）	287	111	χ²=4.211	0.040
高中分化（例）	256	100	χ²=2.523	0.112
肝外侵犯（例）	37	11	χ²=0.151	0.697
脉管浸润（例）	69	28	χ²=0.271	0.603
神经侵犯（例）	43	15	χ²=0	＞0.999
术后并发症（例）	62	27	χ²=0.696	0.404
ASA评分≤2分（例）	321	115	χ²=0	＞0.999
CA19-9＞37 kU/L（例）	116	38	χ²=0.318	0.573
AFP＞25 μg/L（例）	109	48	χ²=2.294	0.130
CEA＞5 μg/L（例）	81	21	χ²=2.222	0.136
切缘距离＞2 cm（例）	146	44	χ²=1.410	0.235
阳性淋巴结（例）	52	24	χ²=1.013	0.314
肿瘤最大径[cm，M（Q₁，Q₃）]	6.5（4.0，8.1）	7.3（5.0，9.0）	Z=-3.107	0.002
肿瘤数目[个，M（Q₁，Q₃）]	1.0（1.0，1.0）	1.0（1.0，2.0）	Z=-3.037	0.002
手术时间[min，M（Q₁，Q₃）]	208（51，324）	166（44，275）	Z=-2.604	0.009
术中出血量[ml，M（Q₁，Q₃）]	3 42（143，400）	316（150，400）	Z=-0.484	0.628

指标	非VER组	VER组	统计值	P值
年龄[岁，M（Q₁，Q₃）]	59（51，65）	55（46，61）	Z=-3.402	0.001
性别（例，男/女）	188/140	82/35	χ²=5.369	0.021
肝胆肿瘤家族史（例）	27	11	χ²=0.038	0.845
乙肝史（例）	120	47	χ²=0.332	0.564
肝切除史（例）	12	0	χ²=3.115	0.078
Child-Pugh A级（例）	206	69	χ²=0.386	0.534
术前新辅助治疗	17	10	χ²=2.193	0.334
淋巴结转移（例）	56	11	χ²=3.391	0.066
腹腔镜手术（例）	300	113	χ²=2.661	0.103
淋巴结清扫（例）	109	41	χ²=0.059	0.809
肿块型（例）	223	84	χ²=0.420	0.517
腺癌（例）	287	111	χ²=4.211	0.040
高中分化（例）	256	100	χ²=2.523	0.112
肝外侵犯（例）	37	11	χ²=0.151	0.697
脉管浸润（例）	69	28	χ²=0.271	0.603
神经侵犯（例）	43	15	χ²=0	＞0.999
术后并发症（例）	62	27	χ²=0.696	0.404
ASA评分≤2分（例）	321	115	χ²=0	＞0.999
CA19-9＞37 kU/L（例）	116	38	χ²=0.318	0.573
AFP＞25 μg/L（例）	109	48	χ²=2.294	0.130
CEA＞5 μg/L（例）	81	21	χ²=2.222	0.136
切缘距离＞2 cm（例）	146	44	χ²=1.410	0.235
阳性淋巴结（例）	52	24	χ²=1.013	0.314
肿瘤最大径[cm，M（Q₁，Q₃）]	6.5（4.0，8.1）	7.3（5.0，9.0）	Z=-3.107	0.002
肿瘤数目[个，M（Q₁，Q₃）]	1.0（1.0，1.0）	1.0（1.0，2.0）	Z=-3.037	0.002
手术时间[min，M（Q₁，Q₃）]	208（51，324）	166（44，275）	Z=-2.604	0.009
术中出血量[ml，M（Q₁，Q₃）]	3 42（143，400）	316（150，400）	Z=-0.484	0.628

参数	单因素分析			多因素分析
参数	OR	95%CI	P值	OR	95%CI	P值
性别女	0.57	0.36～0.9	0.016	0.51	0.32～0.84	0.007
年龄	0.97	0.95～0.99	0.002	0.97	0.95～0.99	0.009
手术时间	1.00	1.00～1.00	0.010	1.00	1.00～1.00	0.119
肿瘤多发	1.31	1.10～1.56	0.003	1.28	1.06～1.54	0.009
肿瘤最大径	1.08	1.01～1.15	0.018	1.10	1.02～1.17	0.007
腺癌	0.38	0.16～0.92	0.031	0.40	0.16～0.99	0.047

参数	单因素分析			多因素分析
参数	OR	95%CI	P值	OR	95%CI	P值
性别女	0.57	0.36～0.9	0.016	0.51	0.32～0.84	0.007
年龄	0.97	0.95～0.99	0.002	0.97	0.95～0.99	0.009
手术时间	1.00	1.00～1.00	0.010	1.00	1.00～1.00	0.119
肿瘤多发	1.31	1.10～1.56	0.003	1.28	1.06～1.54	0.009
肿瘤最大径	1.08	1.01～1.15	0.018	1.10	1.02～1.17	0.007
腺癌	0.38	0.16～0.92	0.031	0.40	0.16～0.99	0.047

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