Oncotarget: Effect of liver fibrosis on survival in patients with intrahepatic cholangiocarcinoma

Oncotarget recently published "Effect of liver fibrosis on survival in patients with intrahepatic cholangiocarcinoma: a SEER population-based study" which reported that the impact of fibrosis on overall and cancer-specific survival 12, 36, and 60 months following diagnosis, was evaluated in the entire cohort and in subgroups stratified according to treatment approach and the American Joint Committee on Cancer tumor stage using a Cox proportional-hazards model.

After adjusting for age, sex, race, year of diagnosis, AJCC stage, and surgical treatment strategy, advanced fibrosis was associated with worse cancer-specific survival across follow-up periods.

Similar effects were observed for overall survival.

Among patients that underwent surgical resection, advanced fibrosis was associated with worse overall survival and cancer-specific survival across follow-up periods.

Fibrosis was associated with worse overall and cancer-specific survival in patients with a later stage at diagnosis but this effect was not demonstrated in early stages.

Patients with iCCA and advanced liver fibrosis have an increased risk of both overall and cancer-specific mortality compared to patients with earlier stages of fibrosis.

Dr. Ofer Isakov from The Tel Aviv Sourasky Medical Center and Sackler School of Medicine said, "Cholangiocarcinoma (CCA) is a malignant neoplasm of the biliary tract. Accounting for ~15% of all primary liver cancers, it is the most common biliary malignancy."

Figure 2: Flowchart depicting patient selection process from SEER database.

Specific risk factors identified for iCCA include certain parasitic infections and anatomical disorders such as choledochal cysts, hepatolithiasis, and primary sclerosing cholangitis.

Liver cirrhosis is also associated with CCA, especially iCCA.

While there is strong evidence to support the causative role of cirrhosis in the development of iCCA, the role of cirrhosis as a prognostic factor is debatable with contradicting findings from previous studies.

In this study, the Oncotarget authors aimed to assess the effect of cirrhosis on outcomes in iCCA patients.

The Oncotarget authors aimed to assess the effect of cirrhosis on outcomes in iCCA patients

For this purpose, the largest cohort of iCCA patients to-date was analyzed in order to elucidate the association between advanced liver fibrosis and all-cause mortality and cancer-specific mortality in iCCA patients.

The Isakov Research Team concluded in their Oncotarget Research Paper, "we show that patients with iCCA and advanced liver fibrosis have an increased risk of both overall and cancer-specific mortality across the follow up period. This association remains significant regardless of whether or not surgical resection was performed. In a sub-cohort of iCCA patients with early stages of the disease, advanced fibrosis was not associated with mortality and therefore, when no other contra-indications are present, should not affect surgical treatment strategy."

DOI - https://doi.org/10.18632/oncotarget.27820

Full text - https://www.oncotarget.com/article/27820/text/

Correspondence to - Ofer Isakov - oferis@tlvmc.gov.il

Keywords - liver fibrosis, cholangiocarcinoma, SEER, survival, cirrhosis

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