Abstract: Objective To investigate the outcomes of actual long-term survival in patients with hepatitis B virus-related intrahepatic cholangiocarcinoma (ICC) after surgical resection, identify the associated predictive factors, and to establish a nomogram for predicting survival. Methods This study was conducted on ICC patients who underwent liver resection from January 2011 to December 2014 at the eastern hepatobiliary surgery hospital. The patients were divided into a ‘long-term survivor group’ and a ‘short-term survivor group’ according to their 5-years survival. Clinical and pathological characteristics between the two groups were compared using univariate and multivariate logistic regression analyses to identify the independent factors associated with actual long-term survival and establish a predictive nomogram. The model performance was assessed in the testing group. Results A total of 508 patients were collected in this study, with an actuarial long-term survival rate of 23.4%. After excluding 59 survival patients that had less than 5 years of follow-up, 85 patients survived more than 5 years postoperatively, and 364 patients died within 5 years after liver resection, resulting in an actual long-term survival rate of 18.9%. Multivariate logistic regression analysis revealed that HBV DNA > 2000 IU/mL, CA19-9, maximum tumor diameter > 5cm, multiple tumors, peritumoral tissue invasion, vascular invasion, and lymph node metastasis were independent associated factors with patients’ actual long-term survival. The nomogram model built based on independent risk factors had a concordance index (C-index) of 0.831 (95%CI: 0.786-0.876) in the modeling group and 0.804 (95%CI: 0.702-0.906) in the testing group, with the model prediction curve closely aligning with the calibrated prediction curve. Conclusion Nearly 1/5 of patients with HBV-related ICC achieve more than 5 years of long-term survival postoperatively. Long-term survivors typically exhibit lower levels of HBV DNA and CA19-9, solitary tumor with diameter no more than 5cm, and absence of peritumoral tissue invasion, vascular invasion, and lymph node metastasis. The nomogram constructed with independent risk factors can predict long-term survival after liver resection for HBV-related ICC effectively.

Key words: Hepatitis B virus, Intrahepatic cholangiocarcinoma, Actual long-term survival, Prognosis, Nomogram