Introduction: Cholangiocarcinoma is the second most common primary liver tumour worldwide with an increasing incidence in recent decades. While the effects of fibrosis on hepatocellular carcinoma have been widely demonstrated, the impact on cholangiocarcinoma remains unclear. The aim of this study was to evaluate the impact of liver fibrosis on overall survival (OS) and disease-free survival (DFS) in patients who have undergone liver resection for cholangiocarcinoma. Methods: Eighty patients with cholangiocarcinoma who underwent curatively intended liver surgery between January 2007 and December 2020 were included in this retrospective single-centre study. Clinical and histopathological features were analysed. The primary endpoint was cause-specific survival. Secondary endpoints were DFS and identification of prognostic factors. Results: The present study shows that the median OS is significantly reduced in patients with fibrosis (p < 0.001). The median OS in patients with fibrosis was three times shorter than in the group without fibrosis. In addition, a significantly shorter DFS was observed in patients with fibrosis (p < 0.002). Multivariate analysis showed that fibrosis is the strongest independent factor with a negative impact on OS and DFS. Conclusion: Liver fibrosis has a significant impact on OS and DFS in patients with cholangiocarcinoma. Patients with known liver fibrosis require thorough perioperative care and postoperative follow-up.

1.
Banales
JM
,
Marin
JJG
,
Lamarca
A
,
Rodrigues
PM
,
Khan
SA
,
Roberts
LR
, et al
.
Cholangiocarcinoma 2020: the next horizon in mechanisms and management
.
Nat Rev Gastroenterol Hepatol
.
2020
;
17
(
9
):
557
88
. .
2.
Blechacz
B
.
Cholangiocarcinoma: current knowledge and new developments
.
Gut Liver
.
2017
;
11
(
1
):
13
26
. .
3.
Rizvi
S
,
Gores
GJ
.
Pathogenesis, diagnosis, and management of cholangiocarcinoma
.
Gastroenterology
.
2013
;
145
(
6
):
1215
29
. .
4.
Mavros
MN
,
Economopoulos
KP
,
Alexiou
VG
,
Pawlik
TM
.
Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis
.
JAMA Surg
.
2014
;
149
(
6
):
565
74
. .
5.
Endo
I
,
Gonen
M
,
Yopp
AC
,
Dalal
KM
,
Zhou
Q
,
Klimstra
D
, et al
.
Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection
.
Ann Surg
.
2008
;
248
(
1
):
84
96
. .
6.
Khan
SA
,
Tavolari
S
,
Brandi
G
.
Cholangiocarcinoma: epidemiology and risk factors
.
Liver Int
.
2019
;
39
(
Suppl 1
):
19
31
. .
7.
Clements
O
,
Eliahoo
J
,
Kim
JU
,
Taylor-Robinson
SD
,
Khan
SA
.
Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a systematic review and meta-analysis
.
J Hepatol
.
2020
;
72
(
1
):
95
103
. .
8.
Younossi
Z
,
Anstee
QM
,
Marietti
M
,
Hardy
T
,
Henry
L
,
Eslam
M
, et al
.
Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention
.
Nat Rev Gastroenterol Hepatol
.
2018
;
15
(
1
):
11
20
. .
9.
Levy
NA
,
Kern
G
,
Shepshelovich
D
,
Shibolet
O
,
Hershkoviz
R
,
Isakov
O
.
Effect of liver fibrosis on survival in patients with intrahepatic cholangiocarcinoma: a SEER population-based study
.
Oncotarget
.
2020
;
11
(
47
):
4438
47
. .
10.
van den Broek
MA
,
Olde Damink
SW
,
Dejong
CH
,
Lang
H
,
Malago
M
,
Jalan
R
, et al
.
Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment
.
Liver Int
.
2008
;
28
(
6
):
767
80
. .
11.
Reddy
SK
,
Marsh
JW
,
Varley
PR
,
Mock
BK
,
Chopra
KB
,
Geller
DA
, et al
.
Underlying steatohepatitis, but not simple hepatic steatosis, increases morbidity after liver resection: a case-control study
.
Hepatology
.
2012
;
56
(
6
):
2221
30
. .
12.
Statement TS: The STROBE statement
;
2022
. Available from: https://www.strobe-statement.org/.
13.
Ishak
K
,
Baptista
A
,
Bianchi
L
,
Callea
F
,
De Groote
J
,
Gudat
F
, et al
.
Histological grading and staging of chronic hepatitis
.
J Hepatol
.
1995
;
22
(
6
):
696
9
. .
14.
Ikai
I
,
Arii
S
,
Kojiro
M
,
Ichida
T
,
Makuuchi
M
,
Matsuyama
Y
, et al
.
Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey
.
Cancer
.
2004
;
101
(
4
):
796
802
. .
15.
Murakami
Y
,
Uemura
K
,
Sudo
T
,
Hashimoto
Y
,
Nakashima
A
,
Kondo
N
, et al
.
Prognostic factors after surgical resection for intrahepatic, hilar, and distal cholangiocarcinoma
.
Ann Surg Oncol
.
2011
;
18
(
3
):
651
8
. .
16.
Jeong
S
,
Gao
L
,
Tong
Y
,
Xia
L
,
Xu
N
,
Sha
M
, et al
.
Prognostic impact of cirrhosis in patients with intrahepatic cholangiocarcinoma following hepatic resection
.
Can J Gastroenterol Hepatol
.
2017
;
2017
:
6543423
. .
17.
Zhang
JX
,
Li
P
,
Chen
Z
,
Lin
H
,
Cai
Z
,
Liao
W
, et al
.
Impact of liver fibrosis score on prognosis after common therapies for intrahepatic cholangiocarcinoma: a propensity score matching analysis
.
BMC Cancer
.
2020
;
20
(
1
):
556
. .
18.
Abdelwahab
M
,
El Nakeeb
A
,
Salah
T
,
Hamed
H
,
Ali
M
,
El Sorogy
M
, et al
.
Hilar cholangiocarcinoma in cirrhotic liver: a case-control study
.
Int J Surg
.
2014
;
12
(
8
):
762
7
. .
19.
Kamarajah
SK
.
Fibrosis score impacts survival following resection for hepatocellular carcinoma (HCC): a Surveillance, End Results and Epidemiology (SEER) database analysis
.
Asian J Surg
.
2018
;
41
(
6
):
551
61
. .
20.
Zhou
XD
,
Tang
ZY
,
Yang
BH
,
Lin
ZY
,
Ma
ZC
,
Ye
SL
, et al
.
Experience of 1,000 patients who underwent hepatectomy for small hepatocellular carcinoma
.
Cancer
.
2001
;
91
(
8
):
1479
86
. .
You do not currently have access to this content.