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Perineural Invasion: Independent Predictor of Recurrence After Surgery for Intrahepatic Cholangiocarcinoma?

By: Justine Landin, PhD
Posted: Friday, September 30, 2022

Perineural invasion may increase tumor recurrence and reduce the likelihood of survival for patients after resection of intrahepatic cholangiocarcinoma, according to Timothy M. Pawlik, MD, of The Ohio State University Wexner Medical Center, Columbus, and colleagues. In fact, perineural invasion was found to reduce overall survival by more than 1.5 times, even for patients with early-stage disease. The findings of this multicenter, retrospective study were published in the British Journal of Surgery.

“Of note, among patients with early-stage AJCC T1–2 or N0 disease, the presence of perineural invasion was strongly associated with both recurrence and overall survival. Perineural invasion should also be strongly considered as a possible indication for adjuvant therapy after resection of [intrahepatic cholangiocarcinoma] given its associated poor prognosis,” stated the study investigators.

Clinical information was gathered from patients with intrahepatic cholangiocarcinoma who had undergone resection for curative intent (n = 1,095). Patients were stratified into groups based upon disease stage. The impact of perineural invasion on clinicopathology and long-term prognosis was examined using univariable and multivariable analyses.

Perineural invasion was detected in a total of 239 patients with intrahepatic cholangiocarcinoma (21.8%). Median disease-free survival for patients with perineural invasion (13.2 months) was reduced compared with patients without perineural invasion (16.1 months, P = .038). Median overall survival was reduced by 15.1 months in patients with perineural invasion compared with patients without perineural invasion (26.4 vs. 41.5 months, P < .001).

The study authors identified perineural invasion as an independent risk factor associated with disease-free and overall survival (P = .019, P = .007, respectively). The association between perineural invasion and reduction in disease-free and overall survival remained even within the patient group who had early-stage disease compared with patients who had later-stage disease. 

Disclosure: The study authors reported no conflicts of interest.

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