Tumor size and survival in intrahepatic cholangiocarcinoma treated with surgical resection or ablation

Abstract

AbstractObjectivesWe performed a retrospective analysis within a national cancer registry on outcomes following resection or ablation for intrahepatic cholangiocarcinoma (iCCA).MethodsThe National Cancer Database was queried for patients with clinical stage I–III iCCA diagnosed during 2010–2018, who underwent resection or ablation. Overall survival (OS) was compared with Kaplan–Meier and multivariable Cox proportional hazards methods.ResultsOf 2140 patients, 1877 (87.7%) underwent resection and 263 (12.3%) underwent ablation, with median tumor sizes of 5.5 and 3 cm, respectively. Overall, resection was associated with greater median OS (41.2 months (95% confidence interval [95% CI]: 37.6–46.2) vs. 28 months (95% CI: 15.9–28.6) on univariable analysis (p < 0.0001). There was no significant difference on multivariable analysis (p = 0.42); however, there was a significant interaction between tumor size and management. On subgroup analysis of patients with tumors <3 cm, there was no difference in OS between resection versus ablation. However, ablation was associated with increased mortality for tumors ≥3 cm.ConclusionAlthough resection is associated with improved OS for tumors ≥3 cm, we observed no difference in survival between management strategies for tumors < 3 cm. Ablation may be an alternative therapeutic strategy for small iCCA, particularly in patients at risk for high surgical morbidity.