Conditional Survival Estimates After Resection for Intrahepatic Cholangiocarcinoma
In a study reported in JAMA Surgery, Spolverato et al derived 3-year conditional survival estimates for patients in a multi-institutional database who underwent liver resection for intrahepatic cholangiocarcinoma. Among all patients, actuarial overall survival was 16% at 8 years, whereas 3-year conditional survival was 65% in those surviving 5 years.
The study involved data from 535 patients in an international multi-institutional database who underwent resection between January 1990 and December 2013. Conditional survival estimates were calculated as the probability of survival for an additional 3 years.
Findings in the Entire Cohort
In the entire cohort of patients, actuarial overall survival was 39% at 3 years, 25% at 5 years, and 16% at 8 years. Among all patients, 3-year conditional survival was 38% among patients surviving at 1 year after surgery, 48% at 2 years, 58% at 3 years, and 65% at 4 years and at 5 years.
Risk Groups
Factors associated with poorer overall survival included multifocal disease, larger lesion size, lymph node metastasis, and vascular tumor invasion. With regard to these subgroups, among patients with solitary vs multiple lesions, actuarial overall survival was 44% vs 29% at 3 years, 29% vs 17% at 5 years, and 20% vs 7% at 8 years; 3-year conditional survival was 40% vs 34% at 1 year, 57% vs 60% at 3 years, and 68% vs 40% at 5 years. Among patients with a lesion size < 5 cm vs ≥ 5 cm, actuarial survival was 46% vs 36% at 3 years, 33% vs 22% at 5 years, and 27% vs 10% at 8 years; 3-year conditional survival was 44% vs 34% at 1 year, 70% vs 48% at 3 years, and 83% vs 47% at 5 years.
Among patients without vs with lymph node metastasis, actuarial survival was 51% vs 23% at 3 years, 35% vs 11% at 5 years, and 20% vs 6% at 8 years; 3-year conditional survival was 44% vs 24% at 1 year, 57% vs 49% at 3 years, and 59% vs 50% at 5 years. Among patients without vs with vascular tumor invasion, actuarial survival was 43% vs 29% at 3 years, 28% vs 16% at 5 years, and 19% vs 8% at 8 years; 3-year conditional survival was 40% vs 31% at 1 year, 59% vs 50% at 3 years, and 68% vs 44% at 5 years.
The investigators concluded: “Conditional survival estimates may provide critical quantitative information about the changing probability of survival over time among patients undergoing liver resection for [intrahepatic cholangiocarcinoma]. Therefore, such estimates can be of significant value to patients and health care professionals.”
Timothy M. Pawlik, MD, MPH, PhD, of Johns Hopkins University School of Medicine, is the corresponding author of the JAMA Surgery article.
The authors reported no conflicts of interest.
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