Long‐term survivors after curative‐intent resection for intrahepatic cholangiocarcinoma

Objectives The objective of the current study was to characterize prognostic factors related to long‐term recurrence‐free survival after curative‐intent resection of intrahepatic cholangiocarcinoma (ICC). Methods Data on patients who underwent curative‐intent resection for ICC between 2000 and 2020 were collected from an international multi‐institutional database. Prognostic factors were investigated among patients who recurred within 5 years versus long‐term survivors who survived more than 5 years with no recurrence. Results Among 635 patients who underwent curative‐intent resection for ICC, 104 (16.4%) patients were long‐term survivors with no recurrence beyond 5 years after surgery. Patients who survived for more than 5 years with no recurrence were more likely to have less aggressive tumor features, as well as have undergone an R0 resection versus patients who recurred within 5 years after resection. On multivariable analysis, tumor size (>5 cm) (HR: 1.535, 95% CI: 1.254–1.879), satellite lesions (HR: 1.253, 95% CI: 1.003–1.564), and lymph node metastasis (HR: 1.733, 95% CI: 1.349–2.227) were independently associated with recurrence within 5 years. Patients who recurred beyond 5 years (n = 23), 2–5 years (n = 60), and within 2 years (n = 471) had an incrementally worse post‐recurrence survival (PRS, 28.0 vs. 20.0 vs. 12.0 months, p = 0.032). Among patients with N0 status, tumor size (>5 cm) (HR: 1.612, 95% CI: 1.087–2.390) and perineural invasion (PNI) (HR: 1.562,95% CI: 1.081–2.255) were risk factors associated with recurrence. Among patients with N1 disease, only a minority (5/128, 3.9%) of patients survived with no recurrence to 5 years. Conclusion Roughly 1 in 6 patients survived for more than 5 years with no recurrence following curative‐intent resection of ICC. Among N0 patients, tumor recurrence was associated with tumor size and PNI. Only a small subset of N1 patients experienced long‐term survival.