The prognostic impact of microvascular invasion in patients with cholangiocarcinoma: A retrospective study

Cholangiocarcinoma (CCA) is the second most prevalent primary liver cancer. Microvascular invasion (MVI) indicates more aggressive tumor behavior. While surgery is the primary curative treatment, recurrence, especially in the presence of MVI, remains a considerable concern. This study delves into the impact MVI has on the prognosis of CCA patients after surgical resection. This retrospective study was performed on 177 CCA patients who underwent surgical resection between January 2007 and December 2022. The primary study objective was to determine the impact of MVI on prognosis, especially in early-stage T1 and T2 cases. Clinicopathological findings, including tumor size, differentiation, and metastatic lymph node status, were meticulously analyzed. Of the 177 patients, 104 exhibited MVI (the MVI group), and 73 did not (the nMVI group). The MVI group had a higher incidence of metastatic lymph nodes (45.2% vs 19.2%, P  < .01) and poorer tumor differentiation ( P  < .01). Median disease-free survival (DFS) and overall survival (OS) in the MVI group were notably shorter than in the nMVI group ( P  < .01 for both). In the T1 and T2 subgroups, the presence of MVI was consistently correlated with shorter DFS and OS. Multivariate analysis indicated that the presence of MVI, non-achievement of R0 resection, and higher baseline CA 19-9 levels were associated with poorer OS. This study shows that MVI plays a crucial role by negatively influencing the prognosis of CCA patients because its presence is significantly associated with reduced DFS and OS. These findings emphasize the need for vigilant postoperative monitoring and potential targeted treatments for CCA patients exhibiting MVI.