Multifocal T2N0 intrahepatic cholangiocarcinoma (iCCA) is associated with poor overall survival compared to solitary T2N0 tumors, a new study published in Annals of Surgical Oncology found. Moreover, it has a disparate prognosis, which is the case even in patients who are treated with resection.

T2 tumors can be solitary with vascular invasion or multifocal. Multifocal tumors include satellite lesions, multiple lesions, and intrahepatic metastases.

In the present study, a team of researchers led by Gregory C. Wilson, MD, from the Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine in Cincinnati, Ohio evaluated the prognosis of multifocal tumors.

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The study enrolled 4887 patients with iCCA. Of these, 15.2% had solitary T2N0 tumors, 21.3% had multifocal T2N0 tumors, and 63.5% had node-positive tumors.

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Patients with solitary T2N0 tumors had higher rates of resection than those with multifocal T2N0 tumors or node-positive tumors. Median overall survival was also better among patients with solitary T2N0 tumors compared to the other 2 groups.

Statistical analysis revealed that solitary T2N0 tumors were associated with better overall survival than multifocal T2N0 tumors and node-positive tumors. This was the case even in patients who underwent surgical resection with regional lymphadenectomy. Staging criteria should take into account poor outcomes associated with multifocal tumors in the future, the researchers said.

Cholangiocarcinoma is a heterogeneous group of rare malignant tumors that originate from cells of the biliary tree. There are 3 types of cholangiocarcinoma: intrahepatic, perihilar, and distal cholangiocarcinoma based on anatomical origin. 

According to the TNM system, T2 refers to a tumor size between 20 mm and 50 mm and N0 refers to no nearby lymph node involvement. Multifocal tumors are tumors that originate from a unique cellular clone and grow multifocally in a single organ.


Turner KM, Delman AM, Kharofa J, et al. A national assessment of T2 staging for intrahepatic cholangiocarcinoma and the poor prognosis associated with multifocality. Ann Surg Oncol. Published online April 20, 2022. doi:10.1245/s10434-022-11762-3