Tumor burden and morphological subtype are independently associated with long-term survival after surgical resection in intrahepatic cholangiocarcinoma (iCCA), a new study published in the Journal of Gastrointestinal Surgery found. Tumor burden is defined as a combination of the size and number of tumors.

To elucidate whether the impact of tumor burden on survival differed by morphological subtype, a team of researchers led by Timothy M. Pawlik, MD, PhD, MPH, from the Department of Surgery at Ohio State University in Columbus identified patients with iCCA who underwent surgical resections between 1990 and 2016.

Using statistical analyses, the team assessed possible associations between the number of lesions and the size of the largest lesion with overall survival. They then developed separate models to assess the relationship between the number of lesions, the size of the largest lesion, and morphological subtypes to predict overall survival.


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They found that each 1-cm increase in the size of the largest lesion was associated with a 6% increase in the risk of death. Similarly, each additional lesion was associated with a 13% increase in the risk of death.

Morphological subtype was also associated with overall survival in patients with periductal infiltrating or mixed tumors who had a 32% higher risk of death compared to those with mass-forming tumors.

When they developed separate models for each morphological subtype of iCCA, the researchers found that the size of the largest lesion and the number of lesions were both predictive of survival. This was the case in the overall cohort and among patients with mass-forming tumors but not in those with periductal infiltrating or mixed tumors. In patients with these types of tumors, only the number of lesions was predictive of survival.

“These findings may help explain why tumor size is inconsistently reported as a prognostic factor for patients with [iCCA] following surgery,” the researchers concluded.

Reference

Paro A, Hyer JM, Pawlik TM. The impact of tumor burden on survival differs by morphological subtype among patients diagnosed with intrahepatic cholangiocarcinoma. J Gastrointest Surg. Published online April 26, 2022. doi:10.1007/s11605-022-05329-6