Presence of symptoms predicts poor survival and correlates with COX-2 expression in resected intrahepatic cholangiocarcinoma patients

A substantial proportion of patients with intrahepatic cholangiocarcinoma (ICC) present with symptoms such as fever or abdominal pain, which are frequently linked to unfavorable prognostic outcomes. A retrospective analysis of the clinical data from 125 patients diagnosed with ICC was conducted. Univariate and multivariate analyses were carried out to assess overall survival (OS) and disease-free survival (DFS). Subsequently, the patients were stratified into 2 groups based on the presence or absence of symptoms. The presence of symptoms is recognized as a risk factor associated with an unfavorable prognosis (OS: 2.026 [1.133-3.624], P = .017); DFS: 1.590 [1.004-2.517], P = .048). Patients presenting symptoms exhibit a higher prevalence of lymph node metastasis (P = .032), microvascular invasion (P = .041), and higher CA19-9 levels (P = .020). Survival curves revealed that OS (P = .010) and DFS (P = .017) were significantly poorer among patients with ICC exhibiting COX-2 (+). Moreover, an analysis of the immune microenvironment in patients with COX-2 (+) indicated a higher presence of CD163+ cells (P = .018) compared to that of patients with COX-2 (-). ICC patients with symptoms are associated with a dismal prognosis and a pronounced expression of COX-2 within the tumor tissues. Our study suggests that preoperative symptoms may serve as a clinical indicator of aggressive tumor biology and immune microenvironment alterations, and that COX-2 expression may represent a potential therapeutic target.