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Hepato-pancreato-biliary

E191: Recurrent Intrahepatic Cholangiocarcinoma: A Novel Prognostic Model to Predict Post-Recurrence Survival and Guide Treatment of Recurrence

Introduction: Although up to 50-70% of patients with intrahepatic cholangiocarcinoma (ICC) recur following resection, data to predict post-recurrence survival (PRS) and guide treatment of recurrence are limited.

Methods: Patients who underwent resection of ICC between 2000-2020 were identified from an international, multi-institutional database. Clinicopathologic data on primary disease as well as laboratory and radiologic data on recurrent disease were collected. Multivariable cox regression analysis was performed to identify factors associated with PRS. A novel scoring system to predict PRS (PRS score) was developed and internally validated with bootstrapping samples (n=5000 repetitions). The impact of PRS score relative to 1- and 3-year post-recurrence mortality was examined.

Results: Among 986 individuals who underwent resection for ICC, a total of 588 (59.6%) patients developed recurrence at a median follow up of 20.3 months (IQR 10.6-39.5). Among patients who experienced a recurrence, 97 (16.5%) patients underwent re-resection or ablation for recurrent ICC; 88 (15.0%) and 403 (68.5%) patients received intra-arterial treatment or systemic chemotherapy/supportive therapy, respectively. Patient ASA class > 2 (1 point), primary tumor N1/Nx status (1 point), primary R1 resection margin (1 point), primary tumor G3/G4 grade (1 point), CA19-9 > 37 UI/mL (2 points) and CEA > 5 ng/mL (2 points) at time of recurrence, as well as radiologic recurrent bilateral disease (1 point) and early recurrence (< 24 months) (1 point) were included in a PRS score. The PRS score successfully stratified patients relative to 1-, and 3-year PRS (Table) and demonstrated strong discriminatory ability (AUC: 0.70, 95%CI 0.68-0.72; bootstrapping resamples; 0.72, 95%CI 0.70-0.74). Each unit increase in the PRS score was associated with an incrementally higher 1-year post-recurrence mortality (1-unit increase; HR=1.48, 95%CI 1.40-1.57). While a PRS score 0-3 was associated with 1- and 3-year mortality of 13.7% and 37.5% following resection or ablation for recurrent ICC, a PRS score >3 was associated with a high 1- and 3-year mortality of 28.2% and 64.5%, respectively (p=0.03).

Conclusions: The PRS score demonstrated strong discriminatory ability to predict PRS following initial resection of ICC. The PRS score may be a useful tool to guide treatment among patients with recurrent ICC.

Learning Objectives:

  • Upon completion, participants will be able to describe factors associated with post-recurrence survival after initial resection of ICC.
  • Upon completion, participants will be able to risk stratify patients based on the PRS score relative to their risk for 1-year post-recurrence mortality
  • Upon completion, participant will be able to identify individuals who have dismal prognosis following resection or ablation of recurrent ICC.