Tool helps predict bile duct cancer recurrence after resection

Last Updated: 2020-07-14

By David Douglas

NEW YORK (Reuters Health) - A simple online calculator may help clinicians predict the chance of very early recurrence (VER) after curative-intent resection for intrahepatic cholangiocarcinoma (ICC), according to an international group of researchers.

Intrahepatic cholangiocarcinoma has a grave prognosis, "even among patients who undergo curative-intent surgical resection," Dr. Timothy M. Pawlik told Reuters Health by email. "In most cases, we offer patients 'immediate' surgery and unfortunately more than 1 in 5 experience a very early recurrence within 6 months."

"Given that liver resection is a large operation with potential complications, it is obviously quite disappointing to patients and surgeons to have the cancer recur in 6 months or less," he continued. "Data from the current study defines which patients are at highest risk of recurrence within 6 months using a novel predictive tool."

As reported online in JAMA Surgery, Dr. Pawlik of The Ohio State University, Wexner Medical Center, Columbus, and colleagues used an international database to identify 880 patients (median age, 59) who underwent ICC resection between 1990 and 2016.

VER developed in 196 (22.3%). Five-year overall survival was 8.9% in this group, significantly less than the 49.8% seen in patients without VER. The team went on to develop two models.

The preoperative model stratified patients relative to the risk for VER ranging from low risk with a 6-month recurrence-free survival (RFS) of 87.7% to intermediate risk (RFS 72.3%) and high risk (RFS 49.5%). Corresponding RFS proportions for the postoperative model were 90.0%, 73.1% and 48.5%

These models, say the investigators, showed "good predictive accuracy in the training as well as the internal and external validation data sets."

The tool is available online so patients and clinicians can estimate a patient's risk of recurrence very early after surgery, Dr. Pawlik said. (https://bit.ly/2CcRUkP)

"Such data may help inform decisions to treat patients with chemotherapy before surgery -- given the very high risk of recurrence -- as well as identify which patients may benefit the most from surgery," he concluded.

Commenting by email, Dr. Gregory J. Gores of Mayo Clinic, Rochester, Minnesota, told Reuters Health that this "well-executed study... develops a practical model to identify patients with very early recurrence (within 6 months) following surgical resection for intrahepatic cholangiocarcinoma. The information will help identify patients who probably should not currently undergo resection, and in the future those patients who merit effective neoadjuvant or adjuvant therapy with resection."

Dr. Gores, who is past Chair of the Division of Gastroenterology and Hepatology, concluded that "The model does not incorporate genetic information regarding the tumor, and future iterations will likely be refined by such an approach."

SOURCE: https://bit.ly/2CcxA2R JAMA Surgery, online July 8, 2020.