Specific risk factors contributing to early and late recurrences of intrahepatic cholangiocarcinoma after curative resection

BACKGROUND: Most intrahepatic cholangiocarcinoma (ICC) patients experienced tumor recurrences even after curative resection, but the optimal cut-off time point and the specific risk factors for early and late recurrences of ICC have not been clearly defined. The objective of the current study was to define specific risk factors for early and late recurrences of ICC after radical hepatectomy. METHODS: Included in this study were 259 ICC patients who underwent curative surgery at our hospital between January 2005 and December 2009. Recurrences in these patients were followed-up prospectively. Piecewise regression model and the minimum P value approach were used to estimate the optimal cut-off time point for early and late recurrences. Then, Cox’s proportional hazards regression model was used to identify specific independent risk factors for early and late recurrences. RESULTS: Early and late recurrences occurred in 130 and 74 patients, respectively, and the 12th month was confirmed as the optimal cut-off time point for early and late recurrences. Cox’s proportional hazards regression model showed that microvascular invasion (HR = 2.084, 95% CI 1.115–3.897, P = 0.021), multiple tumors (HR = 2.071, 95% CI 1.185–3.616, P = 0.010), abnormal elevation of serum CA19-9 (HR = 1.619, 95% CI 1.076–2.437, P = 0.021), and the negative hepatitis B status (HR = 1.650, 95% CI 1.123–2.427, P = 0.011) were independent risk factors for early recurrence, and HBV-DNA level > 10(6) IU/mL (HR = 1.785, 95% CI 1.015–3.141, P = 0.044) and a hepatolithiasis history (HR = 2.538, 95% CI 1.165–5.533, P = 0.010) contributed to late recurrence independently. CONCLUSION: Specific risk factors and mechanisms may relate to early and late recurrences of ICC after curative resection.