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Molecular factors associated with recurrence and survival following hepatectomy in patients with intrahepatic cholangiocarcinoma: A guide to adjuvant clinical trials

Authors

  • Suzanne C. Schiffman MD,

    1. From the Division of Surgical Oncology, Department of Surgery, University of Louisville and The James Graham Brown Cancer Center, Louisville, Kentucky
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  • Michael R. Nowacki MD,

    1. Norton Hospital Department of Pathology, Louisville, Kentucky
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  • Lena Spencer,

    1. Norton Hospital Department of Pathology, Louisville, Kentucky
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  • Kelly M. McMasters MD, PhD,

    1. From the Division of Surgical Oncology, Department of Surgery, University of Louisville and The James Graham Brown Cancer Center, Louisville, Kentucky
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  • Charles R. Scoggins MD, MBA,

    1. From the Division of Surgical Oncology, Department of Surgery, University of Louisville and The James Graham Brown Cancer Center, Louisville, Kentucky
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  • Robert C.G. Martin MD, PhD

    Corresponding author
    1. From the Division of Surgical Oncology, Department of Surgery, University of Louisville and The James Graham Brown Cancer Center, Louisville, Kentucky
    • Correspondence to: Robert CG Martin, II, MD, PhD, Professor of Surgery Director, Division of Surgical Oncology, University of Louisville, Norton Healthcare Pavilion, 315 East Broadway, Suite 303 Louisville, KY 40202. Fax: 502-629-3030.

      E-mail: robert.martin@louisville.edu

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Abstract

Background

This study sought to determine clinical and molecular factors related to recurrence and survival in patients with ICC following hepatectomy.

Methods

Database review identified 34 patients. Molecular markers (Ki67, p53, beta-catenin) and standard pathological evaluations were performed.

Results

The most common resections were right (n = 11), extended right (n = 8), and left hepatectomy (n = 7). The 30- and 90 -day mortality rates were 5.9% and 11.8%. The median tumor size was 7.8 cm. Nine patients (26.5%) had positive lymph nodes and ten patients (29.4%) received adjuvant therapy. Median follow up was 33.5 months. The median disease-free interval was 6 months. The median overall survival was 37.9 months. Univariate predictors of recurrence were tumor size (P = 0.02) and differentiation (P = 0.05). On multivariate analysis, differentiation (P = 0.03; OR = 0.38; 95% CI: 0.17–0.89) remained significant. Univariate predictors of survival were tumor size (P = 0.02), lymphovascular invasion (P = 0.02), satellite nodules (P = 0.006), beta-catenin expression (P = 0.008), and recurrence (P = 0.026). On multivariate analyses, satellite lesions (P = 0.05, OR = 3.15, 95% CI: 0.96–10.4) and beta-catenin (P = 0.04, OR = 3.23; 95% CI: 1.1–9.7) remained significant and differentiation (P = 0.045; OR = 0.42; 95% CI: 0.18–0.98) was an additional predictor.

Conclusion

Future clinical trials could include certain molecular and pathologic factors to assist in determining the necessity and type of adjuvant therapy. J. Surg. Oncol. 2014 109:98–103. © 2013 Wiley Periodicals, Inc.

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