[1732] Morphologic Features Predict Prognosis in Intrahepatic Cholangiocarcinoma

Zhihong Hu, Anjali Godambe, Beatriz Sanchez, Umesh Kapur, Sherri Yong. Loyola University Medical Center, Maywood, IL

Background: Intrahepatic cholangiocarcinoma (ICC) is an uncommon malignancy with a poor prognosis. The incidence has increased in the recent years. Definitve prognostic factors for patient survival have not been clearly identified.
Design: To determine significant factors associated with outcome, retrospective review of pathological findings of the resected tumors and uninvolved liver were performed in patients from a single tertiary hospital. Tumors were grouped into 5 patterns: ductal, papillary, mucinous, sclerosing and mixed (each pattern ≥ 25% or with HCC component). The tumor was also evaluated for differentiation, lymphovascular invasion (LVI), perineural invasion, size and T(tumor) classification. Steatosis, fibrosis, inflammation and ductal atypia were graded in the uninvolved liver.
Results: The study group was 23 ICC patients resected for ICC from 2001 to 2011 (female:13; male: 10; age: 66.8 ± 11.6 years) with complete clinical and survival data. The overall survival after resection was 1.7 ± 0.5 years. Statistical analysis showed that the survival was significantly associated with tumor stage, LVI and mixed pattern. Survival was not significantly related to the tumor size, differentiation, perineural invasion, or hepatic parenchyma with adjacent bile duct atypia, fibrosis or steatosis (p>0.05). The mean survival for the patients with mixed pattern ICC was significantly lower than those with a solitary pattern (p<0.05).

Univariate Analysis of Survival and Tumor Pathologic Characterstics in ICC Patients

Classification	subclassification	Patient numbers (n)	Survival (years)	p value
Tumor size	<5 cm	8	2.8 ±1.2	0.21
	≥5 cm	15	1.1±0.3
LVI	Absent	10	3.0±1.0	<0.01∗
	Present	13	0.6±0.1
Perineural invasion	Absent	14	1.1±0.3	0.13
	Present	9	2.6±1.1
Tumor staging	I	2	7.7±3.0	<0.01∗
	II	10	1.1±0.2
	III	7	1.3±0.6
	IV	3	1.0±0.1
Tumor pattern	Mixed	14	0.7±0.1	<0.05∗
	Solitary	9	2.9±1.0

Univariate Analysis of Survival and Morphologic Characteristics of Uninvolved Liver

Classification	Sub-classification	Number of patients (n)	Survival years	p value
Liver fibrosis	Absent	4	0.75±0.21	0.43
	Stage I	6	1.5 ± 0.9
	Stage II	5	4.1± 0.9
	Stage III	5	2.0± 0.8
	Stage IV	3	0.8± 0.5
Liver steatosis	Absent	14	1.7 ± 0.7	0.91
	Mild-Severe	9	1.6± 0.5
Adjacent duct atypia	Absent	11	1.2± 0.4	0.39
	Present	11	2.1 ± 0.9

Conclusions: The current findings suggest that tumor staging, LVI, and tumor pattern are independent prognostic factors for ICC after surgery. The mixed pattern ICC has a worse prognosis than a solitary tumor pattern. The backgound inflammation, fibrosis stage and steatosis amount does not appear to affect outcome in our study.
Category: Liver

Monday, March 19, 2012 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 267, Monday Morning