A layered risk framework for non-benchmark intrahepatic cholangiocarcinoma after curative-intent resection: an international multi-institutional analysis.

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2026-09-19 DOI:10.1016/j.hpb.2026.09.003

Kizuki Yuza, Odysseas P Chatzipanagiotou, Christian Hobeika, Federico Aucejo, Hugo P Marques, Tom Hugh, Feng Shen, Shishir K Maithel, Bas Groot Koerkamp, Irinel Popescu, Matthew J Weiss, Guillaume Martel, Carlo Pulitano, George Poultsides, Andrea Ruzzenente, Todd W Bauer, Ana Gleisner, Itaru Endo, Timothy M Pawlik

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引用次数: 0

Abstract

Background: Surgical benchmark (BM) values define attainable perioperative outcomes after curative-intent resection for intrahepatic cholangiocarcinoma (iCCA), yet non-benchmark (non-BM) patients remain poorly characterized. Whether tumor biology refines prognosis beyond BM status remains unclear.

Methods: Patients undergoing curative-intent resection for iCCA at international centers (2000-2023) were classified using published BM criteria. Non-BM patients were stratified as surgical-axis only, medical-axis only, or dual-axis. A five-component biology risk score, tumor burden score (TBS), and BM status were evaluated for overall survival (OS).

Results: Among 1794 patients, 1128 (62.9%) were non-BM. Non-BM iCCA met 6 of 11 benchmark cutoffs, although readmission, severe complications, and 90-day mortality exceeded thresholds. Five-year OS differed between BM and non-BM patients (45.4% vs 37.1%; p < 0.001), but not across non-BM axes. Within non-BM, ≥2 biology risk factors were associated with worse OS (aHR 2.29, 95%CI 1.53-3.44). Five-year OS ranged from 52.8% in BM/low-TBS to 29.1% in non-BM/high-TBS. Biology score remained associated with OS across BM status (aHR 1.34 per factor, 95%CI 1.17-1.54).

Conclusion: Non-BM iCCA comprised most resected patients and met several benchmark cutoffs. Surgical and medical axes captured perioperative complexity without refining long-term prognosis, whereas TBS and pathologic biology provided additional oncologic stratification.

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非基准肝内胆管癌治疗意图切除后的分层风险框架：一项国际多机构分析。

背景：手术基准（BM）值定义了肝内胆管癌（iCCA）术后可达到的围手术期预后，但非基准（非BM）患者的特征仍然很差。肿瘤生物学是否能改善脑转移后的预后尚不清楚。方法：在国际中心（2000-2023）接受治疗意图切除iCCA的患者使用已公布的BM标准进行分类。非bm患者被分层为仅手术轴、仅医学轴或双轴。五组分生物学风险评分、肿瘤负荷评分（TBS）和BM状态评估总生存期（OS）。结果：1794例患者中，非bm患者1128例（62.9%）。非bm iCCA达到了11个基准临界值中的6个，尽管再入院、严重并发症和90天死亡率超过了阈值。BM和非BM患者的5年OS差异（45.4% vs 37.1%, p < 0.001），但非BM轴间无差异。在非bm患者中，≥2个生物学危险因素与较差的OS相关（aHR 2.29, 95%CI 1.53-3.44）。5年OS从BM/低tbs组的52.8%到非BM/高tbs组的29.1%。生物学评分仍然与整个BM状态的OS相关（aHR每因子1.34,95%CI 1.17-1.54）。结论：非bm iCCA包括大多数切除患者，并满足几个基准截止值。外科和医学轴捕获围手术期复杂性，但没有改善长期预后，而TBS和病理生物学提供了额外的肿瘤分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).