Keywords: Intrahepatic cholangiocarcinoma (ICC) comorbidity age-adjusted Charlson Comorbidity Index (ACCI) survival Further research should be focused on the impact of comorbidity therapies. Intrahepatic cholangiocarcinoma (ICC), arising from the epithelial cells of the secondary bile duct and its branch in the liver, is the second most common primary liver malignancy in humans and accounts for up to 15% of primary liver cancer cases, next to hepatocellular carcinoma (HCC) ( 1- 3). Over the past few decades, there has been a rapid uptrend of the incidence of ICC worldwide ( 4, 5). Due to its high mortality and the swift progression of the tumor, therapies for ICC remain deficient ( 6). Surgical resection is still the mainstay for treatment and provides curative opportunity ( 3, 5). In 2011, our institution proposed an outcome study based on a massive cohort of ICC patients who underwent resection. Specifically, the median survival was only 17.6 months ( 7). Such poor survival may be contributed by multiple factors. ICC comprises different morphological features and molecular subsets. Determinant factors, including C-reactive protein (CRP), immune infiltrating condition and pathological characteristics, such as multiple lesions, tumor budding and vascular invasion, have been proven to be highly associated with outcomes after resection ( 8- 11).Ĭomorbidities are chronic conditions that impact patients’ life quality, especially in long-term postoperative recovery. The management of comorbidities in cancer treatment is crucial to physicians. Recent studies have demonstrated the strong influence of comorbidities on survival after surgery in different kinds of solid neoplasms, including vulvar cancer, colorectal cancer and breast cancer ( 12- 14). The Charlson Comorbidity Index (CCI), first proposed in 1984 by reviewing hospital charts, managed to account for the influence of a patients’ comorbidity condition in longitudinal studies ( 15). Since age has been subsequently determined to be correlated with prognosis, Charlson et al.
modified the scoring system with the addition of patients’ age in 1994. The age-adjusted CCI (ACCI) incorporates the age as a correction variable of the final score by adding 1 point for every decade over 40 years old ( 16).
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