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Prognostic implications of tumor histology and microenvironment in surgically resected intrahepatic cholangiocarcinoma: a single institutional experience

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Abstract

Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive malignant neoplasm. Certain histologic features and the tumor microenvironment may impact disease progression. We aim to characterize the clinicopathologic features of ICC to identify prognostic factors. A total of 50 surgically resected ICC (partial or transplant) cases were analyzed. The cohort included 26 men and 24 women with a median age of 62 years. Eighteen (36%) cases were multifocal ICC with a mean largest tumor size of 6.5 cm. Neoadjuvant and adjuvant chemotherapy was done in eight (16%) and 33 (66%) patients, respectively. Histologically, 42 (84%) were small duct type, seven (14%) large duct type, and one mixed (2%). Thirty (60%) cases showed lymphovascular invasion (LVI) and 11 (22%) with perineural invasion (PNI). Twenty-eight (56%) cases demonstrated dense intratumoral hyaline fibrosis and 18 (36%) with tumor necrosis, each ≥ 10% tumor volume. On follow-up, 35 (70%) patients died of disease after a median disease-specific survival (DSS) of 21 months. Univariate analysis revealed that hyaline fibrosis and adjuvant chemotherapy were associated with better DSS, while tumor size, multifocality, necrosis, and peritumoral neutrophil to lymphocyte ratio were associated with worse DSS. In contrast, age, sex, small vs. large duct types, LVI, and individual inflammatory cell counts were not significant prognostic factors. In summary, ICC is a heterogeneous malignancy with variable clinical courses associated with tumor burden, histology, and microenvironment. Targeting specific components within the tumor microenvironments may be a promising approach for treatment in the future.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA

    Irene Y. Chen & Xiaoyan Liao

  2. Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA

    Richard F. Dunne

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Contributions

XL contributed to the study design. IYC, RFD, and XL contributed to data collection and analysis of the results. IYC and XL wrote the first draft of the manuscript. RFD and XL edited and approved the final manuscript.

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Correspondence to Xiaoyan Liao.

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This study was approved by the Institutional Review Board at URMC (STUDY00003839).

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The abstract of this study was presented at 2023 annual conference of United States and Canadian Academy of Pathology (USCAP), New Orleans, LA.

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Chen, I.Y., Dunne, R.F. & Liao, X. Prognostic implications of tumor histology and microenvironment in surgically resected intrahepatic cholangiocarcinoma: a single institutional experience. Virchows Arch (2024). https://doi.org/10.1007/s00428-024-03787-8

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