Factors predicting surgical resection in patients with intrahepatic cholangiocarcinoma and cirrhosis.

Here, we investigate the potential factors that affect the outcome of patients with intrahepatic cholangiocarcinomas (ICC) and cirrhosis. We retrospectively reviewed the clinical data and pathological features of 58 patients with ICC and cirrhosis who underwent liver resection between July 2000 and March 2008, and analyzed the prognostic risk factors by means of univariate and multivariate analyses. The overall morbidity and mortality were 40% and 3.3%, respectively. The overall median survival was 24 months, and the 1-, 3-, and 5-year actuarial survival rates were 53%, 18%, and 10%, respectively. Univariate analysis showed that Child-Pugh classification, hypoalbuminemia, vascular invasion, lymphnodes metastasis, tumor-nodes-metastasis (TNM) staging system, positive surgical margins, and high perioperative blood transfusion volumes were all significantly associated with poor survival. Multivariate analysis confirmed that hypoalbuminemia, vascular invasion, positive surgical margins, and high perioperative blood transfusion volume were survival related, with hazard ratios (HR) of 2.58, 3.12, 3.57, and 1.98, respectively. Surgical resection is an effective treatment for patients affected by ICC and cirrhosis. Predictive factors, including hypoalbuminemia, vascular invasion, positive surgical margins, and high perioperative blood transfusion volumes are all related to poor survival.

Major hepatectomy is a safe modality for the treatment of intrahepatic cholangiocarcinoma in selected patients complicated with cirrhosis.

OBJECTIVE: The objective of this paper is to evaluate the perioperative outcomes of major hepatectomy for intrahepatic cholangiocarcinoma (ICC) in patients with cirrhosis. METHODS: We retrospectively evaluated the preoperative, intraoperative, and postoperative findings in 42 consecutive patients with cirrhosis and in 102 patients with normal livers who underwent major hepatectomy for ICC. RESULTS: Preoperative liver function was worse in patients with cirrhosis compared to patients without cirrhosis. Cirrhotic patients had significantly higher intraoperative blood loss, longer operation time, and longer hospital stay than non-cirrhotic patients. However, the two groups had similar overall morbidity and hospital mortality rates and similar rates of liver failure or other complications. Their R0 resection rates, resection margin widths and disease-free survival rates were also similar. CONCLUSIONS: Major hepatectomy for ICC can be performed in selected cirrhotic patients with acceptable morbidity and mortality rates, as compared to patients without cirrhosis.

Clinicopathological characteristics of intrahepatic cholangiocarcinoma in patients with cirrhosis.

BACKGROUND/AIMS: The purpose of this study was to explore the clinicopathological characteristics of intrahepatic cholangiocarcinoma (ICC) in patients with cirrhosis. METHODOLOGY: A total of 155 patients with ICC were divided into those with cirrhosis (n=52) and those without cirrhosis (n=103). We compared the clinicopathological features of patients in both groups. RESULTS: The prevalence of HBsAg seropositivity and hepatolithiasis in ICC patients with cirrhosis was higher than that in patients without cirrhosis. Compared with noncirrhotic patients, cirrhotic patients had a higher incidence of reduced albumin (46.1% vs. 25.2%, p<0.008) and elevated total bilirubin (TBIL) levels (44.2% vs. 24.3%, p=0.011). The resectability rate in cirrhotic patients was lower than that in noncirrhotic patients (63.7% vs. 80.6%, p=0.033). CONCLUSIONS: Among ICC patients, we found marked differences in clinicopathological characteristics and therapeutic approaches between cirrhotic and noncirrhotic patients. ICC patients with cirrhosis may have poorer prognosis than those without cirrhosis.

Prognostic value of cirrhosis for intrahepatic cholangiocarcinoma after surgical treatment.

BACKGROUND: The surgical outcome and prognostic factors of intrahepatic cholangiocarcinoma are not fully understood. This study aimed to establish the clinical significance of cirrhosis for prognosis in patients with intrahepatic cholangiocarcinoma after surgery. METHODS: One hundred fifteen patients with intrahepatic cholangiocarcinoma who underwent surgical resection between December 2001 and January 2008 were retrospectively analyzed. The prognostic significance of clinicopathologic factors including cirrhosis was assessed by univariate and multivariate analyses. RESULTS: Thirty-two of the 115 patients (28%) had liver cirrhosis. Complete tumor removal (R0 resection) was performed in 42 patients (75%). Overall median survival time was 21 months, with 1-, 3-, and 5-year actuarial survival rates of 68%, 27%, and 17%, respectively. There was a significant difference in survival between patients with cirrhosis and those without cirrhosis (P = 0.027). Univariate analysis showed that cirrhosis, vascular invasion, hepatic duct invasion, lymph node metastasis, positive surgical margin (R1), and TNM stage were significantly associated with poor survival. Multivariate analysis showed that cirrhosis, positive surgical margin, and lymph node metastases were related to survival, with hazard ratios of 2.49, 3.53, and 4.16, respectively. CONCLUSIONS: Cirrhosis is an independent factor for poor prognosis in intrahepatic cholangiocarcinoma after surgery.

[Expression of X-linked inhibitor of apoptosis protein in colorectal cancer tissues].

OBJECTIVE: To investigate the expression of X-linked inhibitor of apoptosis protein (XIAP) in colorectal cancer tissues and investigate its correlation with the clinicopathological factors of the malignancy. METHODS: Immunohistochemistry and RT-PCR was employed to detect the expression of XIAP in 87 colorectal cancer tissues. RESULTS: XIAP mRNA expression was detected in 64.4% (56/87) of the colorectal cancer tissues, 49.4% (43/87) of the adjacent tissues, and in 11.4% (10/87) of the normal tissues, respectively. The cancer tissues showed significant greater positivity rate and higher expression level of XIAP mRNA than the adjacent and normal tissues. Immunohistochemistry also identified a significantly greater positivity rate for XIAP [70.1% (61/87)] in the colorectal cancer tissues. The pathological grade of the tumors was associated with the expression level of XIAP, whereas this association was not established between XIAP expression and the clinical stages, tumor position or lymph node metastasis. CONCLUSION: XIAP may play an important role in the development of colorectal cancer, which might serve as a potentially useful tumor marker.

[Sentinel lymph node mapping in colorectal cancer: study of 45 cases].

OBJECTIVE: To discuss the sentinel lymph node (SLN) mapping technique in colorectal cancer and its feasibility and utility. METHODS: The dye lymphazurin was injected subserosally around the tumor during operation in 43 colorectal cancer, 20 males and 25 females, aged 49.5 (27 - 72) so as to find the SLNs. Fast-frozen pathology and routine pathology were performed too. RESULTS: SLN was successfully identified in 42 of the 45 patients, with a successful biopsy rate of 93.3%. In these 45 patients, there were 250 lymph nodes examined, of which 52 nodes were identified as SLNs. The sensitivity was 90.4% (20/22), the specificity was 95.2% [(20 + 20)/42], and the false negative rate was 15% (3/20). CONCLUSION: SLN mapping in colorectal cancer plays an important role in diagnosing metastasis of lymph nodes, and can be used to direct the clinical surgery.