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Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches

2020Journal article Open access
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dc.contributor.authorTsilimigras, D
dc.contributor.authorSahara, K
dc.contributor.authorWu, L
dc.contributor.authorMoris, D
dc.contributor.authorBagante, F
dc.contributor.authorGuglielmi, A
dc.contributor.authorAldrighetti, L
dc.contributor.authorWeiss, M
dc.contributor.authorBauer, T
dc.contributor.authorAlexandrescu, S
dc.contributor.authorPoultsides, G
dc.contributor.authorMaithel, S
dc.contributor.authorPinto Marques, H
dc.contributor.authorMartel, G
dc.contributor.authorPulitano, C
dc.contributor.authorShen, F
dc.contributor.authorSoubrane, O
dc.contributor.authorKoerkamp, B
dc.contributor.authorMoro, A
dc.contributor.authorSasaki, K
dc.contributor.authorAucejo, F
dc.contributor.authorZhang, XF
dc.contributor.authorMatsuyama, R
dc.contributor.authorEndo, I
dc.contributor.authorPawlik, T
dc.date.accessioned2021-07-15T15:50:01Z
dc.date.available2021-07-15T15:50:01Z
dc.date.issued2020
dc.description.abstractImportance: 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. Objective: To predict very early recurrence (VER) (ie, recurrence within 6 months after surgery) following resection for ICC in the pre- and postoperative setting. Design, setting, and participants: Patients who underwent curative-intent resection for ICC between May 1990 and July 2016 were identified from an international multi-institutional database. The study was conducted at The Ohio State University in collaboration with all other participating institutions. The data were analyzed in December 2019. Main outcomes and measures: Two logistic regression models were constructed to predict VER based on pre- and postoperative variables. The final models were used to develop an online calculator to predict VER and the tool was internally and externally validated. Results: Among 880 patients (median age, 59 years [interquartile range, 51-68 years]; 388 women [44.1%]; 428 [50.2%] white; 377 [44.3%] Asian; 27 [3.2%] black]), 196 (22.3%) developed VER. 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 discrete 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; bootstrapping resamples, n = 5000) and external (C index: postoperative, 0.672) validation data sets. Conclusion and relevance: An easy-to-use online calculator 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. This tool may help clinicians in the preoperative selection of patients for neoadjuvant therapy as well as during the postoperative period to inform surveillance strategies.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJAMA Surg. 2020 Sep 1;155(9):823-831.pt_PT
dc.identifier.doi10.1001/jamasurg.2020.1973pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3771
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherAmerican Medical Associationpt_PT
dc.subjectAgedpt_PT
dc.subjectBile Duct Neoplasmspt_PT
dc.subjectCholangiocarcinomapt_PT
dc.subjectCohort Studiespt_PT
dc.subjectDisease-Free Survivalpt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectLogistic Modelspt_PT
dc.subjectMalept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectNeoadjuvant Therapypt_PT
dc.subjectNeoplasm Recurrence, Localpt_PT
dc.subjectPredictive Value of Testspt_PT
dc.subjectRisk Assessmentpt_PT
dc.subjectSurvival Ratept_PT
dc.subjectHepatectomypt_PT
dc.subjectHCC CIRpt_PT
dc.titleVery Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approachespt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage831pt_PT
oaire.citation.issue9pt_PT
oaire.citation.startPage823pt_PT
oaire.citation.titleJAMA Surgerypt_PT
oaire.citation.volume155pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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