The Effect Of Surgical Margin For The Prognosis Of Intrahepatic Cholangiocarcinoma Patients With Different Causative Risk

Aims: Intrahepatic cholangiocarcinoma(ICC)is the second most common malignant tumor in liver cancer,which the incidence of cancer is only lower than hepatocellular carcinoma(HCC),Liver resection is the first choice and effective treatment for ICC.The role of surgical margin for the prognosis of ICC patients remains controversial.At present the more consistent view is that margin is an important factor affecting prognosis,This study mainly explored the relationship between the surgical margin and the prognosis of ICC patients,and to analyze the role of surgical margin in the prognosis of ICC patients with different causative risk factor.Methods: The collected data of patients who underwent liver resection for ICC between 2008 and 2010 at the Eastern Hepatobiliary Surgery Hospital(EHBH)were reviewed.There were 796 ICC patients included in our study.The clinical pathological data of these patients were collected and analyzed statistically.796 ICC patients were divided into four groups according to hepatolithiasis and hepatitis B virus(HBV)infection.The four groups were HBV associated ICC,hepatolithiasis associated ICC,HBV plus hepatolithiasis associated ICC and non HBV non hepatolithiasis associated.Wide margin is defined as the shortest distance from the surgical margin to the tumor ? 1cm,and narrow margin is defined as the shortest distance < 1cm.The role of surgical margin in the prognosis of ICC patients was analyzed in different groups.In further,HBV associated ICC patients were also divided into groups according to MVI and tumor size,and to explore the relationship between the surgical margin and prognosis in these groups.Results: A total of 796 ICC patients were included in this study.There were 537 patients in HBV associated ICC group,98 patients in hepatolithiasis associated ICC,76 patients in HBV plus hepatolithiasis associated ICC group and 85 patients in non HBV non hepatolithiasis associated ICC group,respectively.The results showed that narrow surgical margin was an independent risk factor of overall survival(OS)and tumor recurrence for hepatolithiasis associated ICC(hazard ratio [HR],95% CI: 1.935,1.122-3.337;2.639,1.473-4.727)and HBV plus hepatolithiasis associated ICC(1.873,1.003-3.500;2.500,1.299-4.810).And for HBV associated ICC and non HBV non hepatolithiasis associated ICC,narrow surgical margin was not an independent risk factor of OS and tumor recurrence.Further,HBV related ICC were divided into MVI positive group(n = 97)and MVI negative group(n = 440).Results showed that narrow surgical margin was an independent risk factor of OS and tumor recurrence in MVI positive group(3.673,2.044-6.603;2.026,1.224-3.353).For HBV related ICC with MVI negative,narrow surgical margin was not an independent risk factor of OS and tumor recurrence.HBV related ICC patients were also divided into tumor size ?5 cm group(n = 336)and tumor size <5 cm group(n = 201).For patients with tumor size ? 5cm,narrow surgical margin was an independent risk factor of OS and tumor recurrence(1.369,1.053-1.780;1.368,1.040-1.800).However,narrow surgical margin did not influence the prognosis of patients with tumor size < 5cm.Conclusions: The size of surgical margin(wide or narrow margin)has different effects on the prognosis of ICC patients with different causes.For hepatolithiasis associated ICC patients or HBV associated ICC with tumor diameter ?5cm or MVI positive,wide surgical margin could help to improve the prognosis.