Survival Outcomes in Patients with iCCA and Solitary versus Multiple Tumors

Previously, the staging system developed by the American Joint Committee on Cancer (AJCC) for intrahepatic cholangiocarcinoma (iCCA) separated a solitary tumor without vascular invasion and multiple tumors with or without vascular invasion into different categories, T2a and T2b. The latest staging system by AJCC groups a solitary tumor with vascular invasion and multiple tumors together as T2. Many recent studies, however, have suggested that patients with multifocal iCCA have a worse prognosis compared with those with a single lesion. Dr So Jeong Yoon reported results from a retrospective study aimed at investigating the risk factors for iCCA and the prognostic significance of tumor multiplicity identified by surgical resection.

Between 2010 and 2019, 257 patients underwent surgery for iCCA and had clinicopathological data available for review. Risk factor analysis identified variables associated with survival of patients with resected iCCA, and survival outcomes were compared between patients with solitary versus multiple tumors. Identified risk factors for survival included preoperative symptoms, tumor size, lymph node ratio, multiplicity, and tumor differentiation.

A total of 82 patients were classified as T2, and among these patients, overall survival (OS) was significantly better in patients with solitary tumors (sT2) compared with those with multiple tumors (mT2; P = .017). Survival was compared among patients with stage II sT2 (II-sT2), stage II mT2 (II-mT2), and stage III disease. OS was 52 months in II-sT2 patients versus 29 months in II-mT2 patients (P = .010), and OS was 15 months in patients with IIIA disease (P = .012 vs II-sT2). OS was not statistically different between patients with II-mT2 disease versus those with stage IIIA or IIIB disease: 29 months versus 15 months and 23 months, respectively.

Results from this study highlight a need for multiplicity to be reflected in the AJCC staging system and suggest this difference should be reflected in the next update of the staging guidelines.

Source: Yoon SJ, Oh S, Jeon HJ, et al. The oncologic implications of tumor multiplicity in intrahepatic cholangiocarcinoma: its prognostic value might be underestimated. Poster presented at: ASCO Gastrointestinal Cancers Symposium, January 19-21, 2023; San Francisco, CA. Abstract 611.