The specific etiology of intrahepatic cholangiocarcinoma (iCCA) may predict the likelihood of recurrence and overall survival (OS) among patients, according to a new study published in BMC Cancer.

The research team retrospectively analyzed 448 patients from China with iCCA who underwent radical resection at 10 different hospitals between 2010 and 2018. The patients were divided into 3 groups based on the etiology of their iCCA: conventional (Con-iCCA, or no identifiable cause), hepatitis B virus (HBV-iCCA), and hepatolithiasis (Stone-iCCA).

“Survival analysis showed that the OS and RFS [recurrence-free-survival] were statistically significant among the three etiological subtypes, and the etiology of [iCCA] was identified as an independent risk factor for OS,” the authors said. “Importantly, different etiology was identified as an independent risk factor for OS in patients with [iCCA] after radical resection.”

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Both univariate and multivariate analyses revealed that etiology was a prognostic factor for OS and RFS in patients with iCCA and was a risk factor for OS among patients with early recurrence. The patients with Stone-iCCA had the poorest overall survival, perhaps due to being diagnosed mostly in the advanced stages of the disease and due to the chronic presence of proinflammatory stones in the body.

These patients had an equivalent RFS to the other 2 etiologies. The authors noted that postoperative adjuvant chemotherapy for patients with Stone-iCCA was able to improve their prognosis.

Overall, the authors found no significant differences in the percentage of patients with early recurrence, overall recurrence, and OS among patients with nonearly recurrence. However, among patients with early iCCA recurrence, there was a significantly lower OS than those with nonearly recurrence.

Those with HBV-iCCA had a better prognosis than those of the other 2 etiologies. The authors suspect this might be due to the widespread epidemics of HBV infection in China, which might activate HBV immune memory and enhance antitumor activity in many individuals in this population.


Li Q, Chen C, Su J, et al. Recurrence and prognosis in intrahepatic cholangiocarcinoma patients with different etiology after radical resection: a multi-institutional study. BMC Cancer. Published online March 22, 2022. doi:10.1186/s12885-022-09448-w