Yutaka Endo, Jun Kawashima, Selamawit Woldesenbet, Miho Akabane, Andrea Ruzzente, Luca Aldrighetti, Matthew J Weiss, Todd W Bauer, Irinel Popescu, George A Poultsides, Minoru Kitago, Federico Aucejo, Hugo P Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François Cauchy, Bas Groot Koerkamp, Itaru Endo, Timothy M Pawlik
{"title":"“极早期”肝内胆管癌行肝切除术的特点及其与糖类抗原的关系19-9。","authors":"Yutaka Endo, Jun Kawashima, Selamawit Woldesenbet, Miho Akabane, Andrea Ruzzente, Luca Aldrighetti, Matthew J Weiss, Todd W Bauer, Irinel Popescu, George A Poultsides, Minoru Kitago, Federico Aucejo, Hugo P Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François Cauchy, Bas Groot Koerkamp, Itaru Endo, Timothy M Pawlik","doi":"10.1002/jso.70071","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The concept of \"very early\" ICC ( ≤ 2 cm, single tumor) has been introduced in the context of LT. Due to the limited number of patients in this subset, the characteristics and long-term outcomes have been ill-defined. We sought to assess long-term outcomes of very early ICC patients undergoing liver resection using a large, multi-institutional database.</p><p><strong>Methods: </strong>Patients who underwent curative-intent hepatectomy for ICC between 1993 and 2023 were identified from the International Intrahepatic Cholangiocarcinoma Study Group database. Multivariable Cox regression analysis was performed to identify the risk factors related to overall survival (OS) and recurrence-free survival (RFS).</p><p><strong>Results: </strong>Among 1868 ICC patients, 86 (4.6%) met the criteria for very early ICC. While patient and tumor characteristics were similar between very early and non-very early ICC, 1-, 3-, and 5-year OS among patients with very early ICC was 92.3% (IQR 86.6-98.4), 72.6% (IQR 62.7-84.1), and 58.0% (IQR 45.9-73.5), respectively, versus 80.8% (IQR 78.9-82.7), 51.0% (IQR 48.4-53.8), and 38.9% (IQR 36.1-41.9), respectively, among non-very early ICC patients (p < 0.01). On multivariable Cox regression analysis, elevated CA19-9 levels were associated with worse OS (HR 3.05, IQR 1.28-7.30, p = 0.01) and RFS (HR 2.88, IQR 1.24-6.66, p = 0.01). Very early ICC patients with higher CA19-9 level were more likely to have metastatic nodal disease (N1: ≥ 40 U/mL n = 11, 40.7%, vs. n = 3, 5.1%, p < 0.001), microvascular invasion ( ≥ 40 U/mL n = 10, 37.0%, vs. n = 4, 6.8%, p < 0.001), and major vascular invasion ( ≥ 40 U/mL n = 8, 29.6%, vs. n = 2, 3.4%, p < 0.01).</p><p><strong>Conclusions: </strong>Very early ICC was associated with favorable long-term outcomes; however, elevated CA19-9 levels identified a subgroup with a much worse prognosis and more aggressive tumor features. CA19-9 may help guide perioperative treatment decisions, including additional treatment after surgical interventions.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Characteristics of \\\"Very Early\\\" Intrahepatic Cholangiocarcinoma Undergoing Liver Resection and Its Relationship With Carbohydrate Antigen 19-9.\",\"authors\":\"Yutaka Endo, Jun Kawashima, Selamawit Woldesenbet, Miho Akabane, Andrea Ruzzente, Luca Aldrighetti, Matthew J Weiss, Todd W Bauer, Irinel Popescu, George A Poultsides, Minoru Kitago, Federico Aucejo, Hugo P Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François Cauchy, Bas Groot Koerkamp, Itaru Endo, Timothy M Pawlik\",\"doi\":\"10.1002/jso.70071\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The concept of \\\"very early\\\" ICC ( ≤ 2 cm, single tumor) has been introduced in the context of LT. Due to the limited number of patients in this subset, the characteristics and long-term outcomes have been ill-defined. We sought to assess long-term outcomes of very early ICC patients undergoing liver resection using a large, multi-institutional database.</p><p><strong>Methods: </strong>Patients who underwent curative-intent hepatectomy for ICC between 1993 and 2023 were identified from the International Intrahepatic Cholangiocarcinoma Study Group database. Multivariable Cox regression analysis was performed to identify the risk factors related to overall survival (OS) and recurrence-free survival (RFS).</p><p><strong>Results: </strong>Among 1868 ICC patients, 86 (4.6%) met the criteria for very early ICC. While patient and tumor characteristics were similar between very early and non-very early ICC, 1-, 3-, and 5-year OS among patients with very early ICC was 92.3% (IQR 86.6-98.4), 72.6% (IQR 62.7-84.1), and 58.0% (IQR 45.9-73.5), respectively, versus 80.8% (IQR 78.9-82.7), 51.0% (IQR 48.4-53.8), and 38.9% (IQR 36.1-41.9), respectively, among non-very early ICC patients (p < 0.01). On multivariable Cox regression analysis, elevated CA19-9 levels were associated with worse OS (HR 3.05, IQR 1.28-7.30, p = 0.01) and RFS (HR 2.88, IQR 1.24-6.66, p = 0.01). Very early ICC patients with higher CA19-9 level were more likely to have metastatic nodal disease (N1: ≥ 40 U/mL n = 11, 40.7%, vs. n = 3, 5.1%, p < 0.001), microvascular invasion ( ≥ 40 U/mL n = 10, 37.0%, vs. n = 4, 6.8%, p < 0.001), and major vascular invasion ( ≥ 40 U/mL n = 8, 29.6%, vs. n = 2, 3.4%, p < 0.01).</p><p><strong>Conclusions: </strong>Very early ICC was associated with favorable long-term outcomes; however, elevated CA19-9 levels identified a subgroup with a much worse prognosis and more aggressive tumor features. CA19-9 may help guide perioperative treatment decisions, including additional treatment after surgical interventions.</p>\",\"PeriodicalId\":17111,\"journal\":{\"name\":\"Journal of Surgical Oncology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-08-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Surgical Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/jso.70071\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jso.70071","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Characteristics of "Very Early" Intrahepatic Cholangiocarcinoma Undergoing Liver Resection and Its Relationship With Carbohydrate Antigen 19-9.
Introduction: The concept of "very early" ICC ( ≤ 2 cm, single tumor) has been introduced in the context of LT. Due to the limited number of patients in this subset, the characteristics and long-term outcomes have been ill-defined. We sought to assess long-term outcomes of very early ICC patients undergoing liver resection using a large, multi-institutional database.
Methods: Patients who underwent curative-intent hepatectomy for ICC between 1993 and 2023 were identified from the International Intrahepatic Cholangiocarcinoma Study Group database. Multivariable Cox regression analysis was performed to identify the risk factors related to overall survival (OS) and recurrence-free survival (RFS).
Results: Among 1868 ICC patients, 86 (4.6%) met the criteria for very early ICC. While patient and tumor characteristics were similar between very early and non-very early ICC, 1-, 3-, and 5-year OS among patients with very early ICC was 92.3% (IQR 86.6-98.4), 72.6% (IQR 62.7-84.1), and 58.0% (IQR 45.9-73.5), respectively, versus 80.8% (IQR 78.9-82.7), 51.0% (IQR 48.4-53.8), and 38.9% (IQR 36.1-41.9), respectively, among non-very early ICC patients (p < 0.01). On multivariable Cox regression analysis, elevated CA19-9 levels were associated with worse OS (HR 3.05, IQR 1.28-7.30, p = 0.01) and RFS (HR 2.88, IQR 1.24-6.66, p = 0.01). Very early ICC patients with higher CA19-9 level were more likely to have metastatic nodal disease (N1: ≥ 40 U/mL n = 11, 40.7%, vs. n = 3, 5.1%, p < 0.001), microvascular invasion ( ≥ 40 U/mL n = 10, 37.0%, vs. n = 4, 6.8%, p < 0.001), and major vascular invasion ( ≥ 40 U/mL n = 8, 29.6%, vs. n = 2, 3.4%, p < 0.01).
Conclusions: Very early ICC was associated with favorable long-term outcomes; however, elevated CA19-9 levels identified a subgroup with a much worse prognosis and more aggressive tumor features. CA19-9 may help guide perioperative treatment decisions, including additional treatment after surgical interventions.
期刊介绍：
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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