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Pronostic du cholangiocarcinome intrahépatique réséqué

Abstract : Introduction. Complete resection stands as the only curative option for intrahepatic cholangiocarcinoma (IHCC). Still, prognosis remains poor after resection due to a recurrence rate over 60% leading to actual 5-year survival rates below 20%. Reliable prognostic estimation and better understanding of tumor biology would be of interest for improving IHCC prognosis.Methods. Using clinical and biological data from two large cohort of resected IHCC (MSKCC, n=189 and AFC, n=522), three objectives have been explored. First, assessing the performances of different published prognostic models. Second, defining the reliability of preoperative prognostic estimation using imaging, tumoral genomic profiling and circulating tumoral microRNA (miR). Third, evaluating the prognostic impact of perioperative events such as blood transfusion and morbidity.Results. First, nomograms displayed better prognostic accuracy over the AJCC 7th edition staging system. Second, tumor size and multifocality on preoperative imaging allowed patient stratification in groups statistically different regarding prognosis (p<0.001). Further, the presence of chromatine remodeling gene mutations (BAP1, ARID1A, PBRM1) tended towards longer recurrence-free survical (p=0,09). Some diagnostic circulating miR such as miR21 and miR221 were not associated with survival. Third, in contrast with intraoperative transfusion, the occurrence of severe morbidity (Dindo-Clavien grade > 2) was independently associated with shorter overall survival (p=0.002).Conclusion. Nomograms outperform conventional staging sytem. Preoperative prognostic estimation is feasible and reliable using imaging. Identifying new prognostic biomarkers would help refining preoperative prognostic estimation.
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Alexandre Doussot. Pronostic du cholangiocarcinome intrahépatique réséqué. Médecine humaine et pathologie. Université Bourgogne Franche-Comté, 2017. Français. ⟨NNT : 2017UBFCI021⟩. ⟨tel-02337972⟩

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