Improving Recurrence Prediction in Intrahepatic Cholangiocarcinoma: The Synergistic Impact of the FIB-4 Index and Tumor Burden Score on Post-hepatectomy Outcomes

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发表日期：

2024年11月7日

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Miho Akabane,
Jun Kawashima,
Selamawit Woldesenbet,
Amanda B. Macedo,
François Cauchy,
Feng Shen,
Shishir K. Maithel,
Bas Groot Koerkamp,
Sorin Alexandrescu,
Minoru Kitago,
Matthew Weiss,
Guillaume Martel,
Carlo Pulitano,
Luca Aldrighetti,
George A. Poultsides,
Yuki Imaoka,
Alfredo Guglielmi,
Todd W. Bauer,
Itaru Endo,
Ana Gleisner,
Hugo P. Marques,
Timothy M. Pawlik

摘要

Background

The prognostic role of the fibrosis-4 (FIB-4) index relative to intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study sought to characterize the impact of the FIB-4 index and tumor burden score (TBS) on recurrence and overall survival (OS).

Methods

ICC patients undergoing hepatectomy (2000–2020) were identified using a multi-institutional database. Patients were categorized as low (low TBS/low FIB-4 index), intermediate (low TBS/high FIB-4 index or high TBS/low FIB-4 index), and high (high TBS/high FIB-4 index).

Results

Among 1168 patients in different TBS and FIB-4 index cohorts, 3-year recurrence varied considerably. For instance, among the patients with low TBS, individuals with a high FIB-4 index had a greater risk of recurrence than patients with a low FIB-4 index (59.9 vs. 47.7%; P = 0.01). Among patients with a high TBS, individuals with a high versus a low FIB-4 index had a higher incidence of recurrence (76.8 vs. 69.0%; P = 0.04). A similar pattern was observed among patients with both a low FIB-4 index (low [47.7%] vs. high [69.0%] TBS) and a high FIB-4 index (low [59.9%] vs. high [76.8%] TBS; both P < 0.001). Patients with a high [27.5%] versus a low [48.8%] TBS; P < 0.001) and patients with a high [34.2%] versus a low [43.5%] FIB-4 index; P = 0.01) had a worse OS. The multivariable analysis demonstrated an increasing risk of recurrence in the intermediate-index (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.20–2.16; P = 0.001) and high-index (HR, 2.13; 95% CI 1.45–3.13; P < 0.001) groups versus the low-index group.

Conclusions

Both tumor-related and non-tumorous characteristics should be used to predict risk of recurrence and survival more accurately among patients with ICC following hepatic resection.