Intrahepatic cholangiocarcinoma tumor size classification based on prognostic analysis: a retrospective multicenter study

doi:10.16139/j.1007-9610.2025.04.07

Journal of Surgery Concepts & Practice ›› 2025, Vol. 30 ›› Issue (04): 332-338.doi: 10.16139/j.1007-9610.2025.04.07

• Original article • Previous Articles Next Articles

Intrahepatic cholangiocarcinoma tumor size classification based on prognostic analysis: a retrospective multicenter study

CHEN Jiaqian¹, LIU Hongzhi¹, MENG Lingtian², ZHOU Weiping³, CHENG Zhangjun⁴, LOU Jianying⁵, ZHENG Shuguo⁶, BI Xinyu⁷, WANG Jianming⁸, GUO Wei⁹, LI Fuyu¹⁰, WANG Jian¹¹, ZHENG Yamin¹², LI Jingdong¹³, CHENG Shi¹⁴, HUANG Yao¹, ZENG Yongyi¹()

1. Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fujian Fuzhou 350001, China
2. Fuzhou University, College of Biological Sciences and Engineering, Fujian Fuzhou 350108, China
3. Department of Hapatic Surgery Ⅲ, Eastern Hepatobiliary Surgery Hospital of Naval Medical University, Shanghai 200433, China
4. Department of Hepatobiliary and Pancreatic Surgery, Zhongda Hospital, Southeast University, Jiangsu Nanjing 210009, China
5. Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Hangzhou 310009, China
6. Department of Biliary Surgery, the Southwest Hospital of Army Medical University, Chongqing 400038, China
7. Department of Hepatobiliary Surgery, Cancer Hospital, Peking Union Medical University, Chinese Academy of Medical Sciences, Beijing 100021, China
8. Department of Biliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Wuhan 430030, China
9. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
10. Department of Biliary Surgery, West China Hospital, Sichuan University, Sichuan Chengdu 610041, China
11. Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
12. Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
13. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Sichuan Nanchong 637000, China
14. Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2025-04-30 Online:2025-07-25 Published:2025-10-23
Contact: ZENG Yongyi E-mail:lamp197311@126.com

Abstract

Abstract:

Objective To retrospectively analyze multicenter data from domestic sources, aiming to explore the link between intrahepatic cholangiocarcinoma (ICC) tumor size and prognosis, establishing a classification system based on tumor size. Methods Between December 2011 and September 2018, 280 ICC patients from 13 hospitals were included. The tumor size prognosis cutoff was identified by the minimum P-value method, and the classification's overall survival related effectiveness was assessed by Kaplan-Meier analysis. Results All 280 patients were divided into the group of tumor maximum diameter ≤4 cm and >4 cm. Tumor size was confirmed as an independent prognosis factor by multivariate COX regression analysis (HR=2.110, 95% CI: 1.358-3.280). Conclusions The tumor size dichotomy classification system based on the Chinese patient group can expediently predict ICC prognosis and offers an important basis for selecting post-operative individualized adjuvant therapy and follow up plans.

Key words: Intrahepatic cholangiocarcinoma (ICC), Tumor size, Prognosis, Retrospective Study

CLC Number:

R735.7

CHEN Jiaqian, LIU Hongzhi, MENG Lingtian, ZHOU Weiping, CHENG Zhangjun, LOU Jianying, ZHENG Shuguo, BI Xinyu, WANG Jianming, GUO Wei, LI Fuyu, WANG Jian, ZHENG Yamin, LI Jingdong, CHENG Shi, HUANG Yao, ZENG Yongyi. Intrahepatic cholangiocarcinoma tumor size classification based on prognostic analysis: a retrospective multicenter study[J]. Journal of Surgery Concepts & Practice, 2025, 30(04): 332-338.

Figures/Tables 5

Tab 1

Tab 2

Fig 1

Fig 2

Tab 3

References 32

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Cut-off (cm)	Log-rank OS P value	COX HR-OS(95% CI)
2	0.195	3.349（0.468-23.984）
3	0.010	2.253（1.185-4.283）
4	<0.001	2.190（1.414-3.394）
5	0.001	1.718（1.221-2.416）
6	0.003	1.625（1.174-2.251）
7	0.012	1.519（1.087-2.121）
8	0.062	1.402（0.976-2.013）
9	0.494	1.155（0.760-1.755）
10	0.191	1.333（0.860-2.068）
11	0.230	1.380（0.807-2.360）

Characteristics	≤4 cm（n=79）	>4 cm（n=201）	P value
Age （years）			0.219
≤60	42（53.2）	123（61.2）
>60	37（46.8）	78（38.8）
Gender			0.085
Male	57（72.2）	123（61.2）
Female	22（27.8）	78（38.8）
Hepatitis viral infection			0.014
No	34（43.0）	119（59.2）
Yes	45（57.0）	82（40.8）
ECOG score			0.120
<2	73（92.4）	172（85.6）
≥2	6（7.6）	29（14.4）
Child-Pugh score			0.453
A	51（64.6）	120（59.7）
B	28（35.4）	81（40.3）
CA19-9（μmol/L）			0.212
≤200	71（89.9）	169（84.1）
>200	8（10.1）	32（15.9）
CEA（μg/L）			0.943
≤5	61（77.2）	156（77.6）
>5	18（22.8）	45（22.4）
TBIL（μmol/L）			0.469
≤20	47（59.5）	110（54.7）
>20	32（40.5）	91（45.3）
Blood transfusion			0.059
No	72（91.1）	165（82.1）
Yes	7（8.9）	36（17.9）
Blood loss（mL）			0.721
≤400	64（81.0）	159（79.1）
>400	15（19.0）	42（20.9）
Anatomical liver resection			0.798
No	43（54.4）	106（52.7）
Yes	36（45.6）	95（47.3）
Microvascular invasion			0.781
No	72（91.1）	181（90.0）
Yes	7（8.9）	20（10.0）
Pathological classification			0.130
Non-mass	19（24.1）	67（33.3）
Mass	60（75.9）	134（66.7）
Histological classification			0.761
Non-adenocarcinoma	8（10.1）	18（9.0）
Adenocarcinoma	71（89.9）	183（91.0）
Satellite nodules			0.976
No	75（94.9）	191（95.0）
Yes	4（5.1）	10（5.0）
Neural invasion			0.869
No	69（87.3）	177（88.1）
Yes	10（12.7）	24（11.9）
Postoperative adjuvant therapy			0.153
No	67（84.8）	155（77.1）
Yes	12（15.2）	46（22.9）
Postoperative complications			0.630
No	60（75.9）	158（78.6）
Yes	19（24.1）	43（21.4）

Factors	Univariate			Multivariate
Factors	P value	HR	95% CI	P value	HR	95% CI
Age（>60 years）	0.835	1.036	（0.743-1.444）
Gender（Male）	0.370	1.172	（0.828-1.660）
Hepatitis viral infection	0.451	1.133	（0.818-1.569）
ECOG score（≥2）	<0.001	2.179	（1.436-3.306）	<0.001	2.192	（1.434-3.349）
Child-Pugh score（B）	0.141	1.278	（0.922-1.770）
CA19-9（>200 μmol/L）	0.081	1.520	（0.950-2.433）
CEA（>5 μg/L）	0.627	1.104	（0.741-1.645）
TBIL（>20 μmol/L）	0.539	1.107	（0.800-1.533）
Blood transfusion	0.393	0.806	（0.492-1.322）
Blood loss（>400 mL）	0.581	0.883	（0.569-1.372）
Anatomical liver resection	0.190	1.250	（0.895-1.745）
Microvascular invasion	0.021	1.794	（1.091-2.950）	0.014	1.875	（1.137-3.094）
Pathological classification（Mass）	0.021	0.676	（0.485-0.942）
Histological classification（Adenocarcinoma）	0.158	1.627	（0.828-3.197）
Satellite nodules	0.009	2.270	（1.224-4.213）	0.005	2.444	（1.130-4.560）
Neural invasion	0.640	1.137	（0.664-1.948）
Postoperative adjuvant therapy	0.614	0.896	（0.586-1.371）
Postoperative complications	0.149	1.331	（0.903-1.964）
Tumor maximum diameter（>4 cm）	<0.001	2.190	（1.414-3.394）	0.001	2.110	（1.358-3.280）

Intrahepatic cholangiocarcinoma tumor size classification based on prognostic analysis: a retrospective multicenter study

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