Faculty Collaboration Database

Is Radiotherapy Warranted Following Intrahepatic Cholangiocarcinoma Resection? The Impact of Surgical Margins and Lymph Node Status on Survival. Ann Surg Oncol 2016 Dec;23(Suppl 5):912-920

Date

09/23/2016

Pubmed ID

27654107

DOI

10.1245/s10434-016-5560-1

Scopus ID

2-s2.0-84988664224 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

BACKGROUND: The role of radiotherapy (RT) for surgically resected intrahepatic cholangiocarcinoma (ICC) remains poorly defined. Radiotherapy is often considered when positive resection margins exist. The present study sought to examine the impact of radiotherapy following ICC resection.

METHODS: Patients with early-stage disease, who underwent surgical resection, were identified from the National Cancer Database (1998-2013). Patients were stratified by the receipt of RT. Survival outcomes were examined following propensity score matching (PS), and a Cox regression for survival analysis was used to examine predictors of survival.

RESULTS: A total of 2897 patients were identified. R0 status was achieved in 1951 patients (67.3 %). RT was delivered to 525 patients (R0 = 255, R1/R2 = 230, unknown = 43). Following PS matching, the overall survival for R0 versus R1/R2 resection was 31.2 versus 19.5 months (p < .001), respectively. RT was associated with a trend toward improved survival for R1/R2 lymph node negative patients (39.5 vs. 21.1 months; p = .052). In a multivariate model accounting for different patient and disease characteristics, RT was not associated with survival. In contrast, age, comorbidities, tumor grade, resection margins, lymph nodes status, and tumor's T stage were identified as negative predictors of survival.

CONCLUSIONS: Patients with negative resection margins demonstrated improved survival outcome among ICC patients. In patients with positive resection margins and node negative disease, radiotherapy did not provide a survival benefit. Further studies are warranted to confirm and further define these results.

Author List

Hammad AY, Berger NG, Eastwood D, Tsai S, Turaga KK, Christian KK, Johnston FM, Pawlik TM, Gamblin TC

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Bile Duct Neoplasms
Bile Ducts, Intrahepatic
Cholangiocarcinoma
Comorbidity
Databases, Factual
Female
Humans
Lymphatic Metastasis
Male
Margins of Excision
Middle Aged
Neoplasm Grading
Neoplasm Staging
Neoplasm, Residual
Propensity Score
Radiotherapy, Adjuvant
Retrospective Studies
Survival Rate