Impact of Surgical Margin Width and Postoperative Adjuvant Therapy on Long-Term Outcomes for Intrahepatic Cholangiocarcinoma: A Propensity Score Matching Analysis
Authors:   Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China, Hongzhi Liu , Lianku Lin ,   Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China, Ziguo Lin ,   Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China, Yifan Chen ,   Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China, Qizhen Huang ,   Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China, Lei Ding ,   College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, China, Jianying Lou ,   Department of Hepatobiliary Surgery, The Second Hospital Affiliated to Zhejiang University, Hangzhou, Zhejiang, China, Shuguo Zheng ,   Department of Hepatobiliary Surgery, The Southwest Hospital Affiliated to the Army Medical University, Chongqing, China, Xinyu Bi ,   Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China, Jianming Wang ,   Department of Hepatobiliary Surgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China, Wei Guo ,   Department of Hepatobiliary Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China, Fuyu Li ,   Department of Hepatobiliary Surgery, The West China Hospital of Sichuan University, Chengdu, Sichuan, China, Jian Wang ,   Department of Hepatobiliary Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China, Yamin Zheng ,   Department of Hepatobiliary Surgery, Xuanwu Hospital Affiliated to Capital Medical University, Beijing, China, Jingdong Li ,   Department of Hepatobiliary Surgery, The Affiliated Hospital of Chuanbei Medical University, Nanchong, Sichuan, China, Shi Cheng ,   Department of Hepatobiliary Surgery, Tiantan Hospital Affiliated to Capital Medical University, Beijing, China, Weiping Zhou ,   Department of Hepatobiliary Surgery Ⅲ, Eastern Hepatobiliary Surgery Hospital, Secondary Military Medical University, Shanghai, China, Zhangjun Cheng ,   Department of Hepatobiliary Surgery, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China, Yongyi Zeng ,   Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China,   College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, China
Published: February 2021

BACKGROUND The objective of this study was to investigate the survival outcomes of surgical margin width in intrahepatic cholangiocarcinoma (ICC), and evaluate the efficacy of postoperative adjuvant therapy (p-AT) in ICC patients underwent narrow-margin hepatectomy (NMH).METHODS Between November 2011 and August 2017, patients who underwent hepatectomy for ICC were collected from 13 major hepatopancreatobiliary centers in China. The survival outcomes for patients who underwent wide margin hepatectomy (WMH) were compared with those who underwent NMH using the 1:1 propensity score matching (PSM). For patients who underwent NMH, the relationship between p-AT and overall survival (OS) and disease-free survival (DFS) were analyzed. RESULTS Among 478 included patients, 195(40.8%) underwent WMH whereas 283(59.2%) underwent NMH. PSM yielded 79 matched patients with similar baseline characteristics. Patients underwent WMH had a significant better OS and DFS compared with those underwent NMH (before PSM: Median OS 27 vs. 17 months, P <0.05; Median DFS 15 vs. 8 months, P = 0.001), (after PSM: Median OS 41 vs. 22 months, p <0.05; Median DFS 16 vs. 10 months, p <0.05). However, based on the AJCC staging system, WMH could only improve the survival outcomes in early ICC patients (Stage I: OS, DFS, P <0.05; Stage II: OS, DFS, P >0.05; Stage III: OS, DFS, P >0.05). For patient underwent NMH, p-AT following NMH showed a better OS and RFS when compared to those who underwent NMH alone (OS, P = 0.05; DFS, p <0.05). CONCLUSION With the current data, we suggest surgeons should strive to achieve a wide surgical margin for patients with early ICC to optimize the long-term outcome. The effect of p-AT for the outcome of ICC patients underwent NMH need to be explored further.