A.Sh. Umirzokov1, A.V. Korshak1, S.N. Korchagina1, V.N. Zhuykov2, V.I. Egorov1, 3, 4, D.M. Kantieva1, I.V. Savchenko1, A.V. Moiseenko2, M.Sh. Manukyan1, A.N. Polyakov1
1N.N. Blokhin National Medical Research Center of Oncology, Moscow
2A.M. Granov Russian Scientific Center for Radiology and Surgical Technologies, Saint Petersburg
3Kazan State Medical University, Kazan
4Republican Clinical Oncology Dispensary named after Prof. M.Z. Sigal, Kazan
Polyakov A.N. — MD, Senior Researcher of the Department of Abdominal Oncology No. 2 (hepatopancreas-biliary tumors)
Address: 24 Kashirskoye shosse, 115478 Moscow, tel.: +7 (903) 588-24-64, e -mail: Dr.alexp@gmail.com, ORCID: 0000-0001-5348-5011, SPIN: 9924-0256
Abstract. Intrahepatic cholangiocarcinoma (ICC) has an unfavorable prognosis even after resection. Evaluation of prognostic factors is necessary to improve patient selection and treatment planning.
The purpose — to identify clinically significant prognostic factors based on a comparison of literature and own data and to substantiate an individual approach to treatment.
Material and Methods. We analyzed literature data (2018–2025) and our own retrospective study of 170 patients after curable resection in ICC (R0–R1) who survived the 90-day postoperative period. Overall (OS) and disease-free survival (DFS) were assessed depending on clinical and morphological factors.
Results. Independent adverse factors were: lymph node damage (OS: HR 1.96; DFS: HR 2.37), invasion of surrounding structures (OS: HR 1.63), multiple liver damage (OS: HR 1.51), and R1 resection (DFS: HR 1.88). The combination of ≥2 factors reduced the OS median from 53 to 24 months (p = 0.001). In contrast to the literature, in our work CA 19-9 and the neutrophil-lymphocytic index did not have independent prognostic significance, but we note the absence of long-term DFS at CA 19-9 over 100. With unfavorable factors, neoadjuvant therapy was associated with an improvement in DFS (17 vs 13 months, p < 0.05).
Conclusion. The prognosis for resectable ICC is determined by a combination of factors rather than individual symptoms. Even extremely unfavorable factors are not an absolute contraindication to resection in selective patients. Individual planning using prognostic scales and consideration of neoadjuvant therapy in high-risk patients are key areas for improving treatment outcomes.
Key words: biliary tract cancer, liver resection, long-term outcomes, survival, negative prognostic factors, prognostic scoring systems