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Chemotherapy for Surgically Resected Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 2015 Oct;22(11):3716-23

Date

03/18/2015

Pubmed ID

25777092

DOI

10.1245/s10434-015-4501-8

Scopus ID

2-s2.0-84941418828   64 Citations

Abstract

BACKGROUND: The benefit of chemotherapy for surgically resected intrahepatic cholangiocarcinoma (ICC) remains poorly defined. The present study sought to determine the survival impact of chemotherapy for surgically resected ICC.

METHODS: Patients with non-metastatic ICC who underwent surgery were identified from the National Cancer Database (1998-2011) and stratified by receipt of chemotherapy. Survival outcomes were analyzed following propensity score modeling using the greedy matching algorithm.

RESULTS: A total of 2751 patients were identified (median age 64 years); 985 (35.8 %) received chemotherapy. Younger age, advanced tumor stage, R1/R2 surgical margins, and lymph node metastasis were all independently associated with receipt of chemotherapy (p < 0.05). Following propensity score matching, advanced tumor stage, lymph node metastasis, poorly differentiated tumors, and R1/R2 surgical margins were associated with poorer overall survival (OS) (p < 0.05). Median OS comparing patients who received chemotherapy compared with surgery alone was 23 versus 20 months (p = 0.09). However, when stratified by lymph node status, chemotherapy demonstrated a significant improvement in median OS among N1 patients (19.8 vs. 10.7 months; p < 0.001). In contrast, patients with N0 disease derived no benefit from chemotherapy (29.4 vs. 29 months; p = 0.33). Additional tumor characteristics associated with improved survival with chemotherapy included T3/T4 tumors (21.3 vs. 15.6 months; p < 0.001) and R1/R2 surgical margins (19.5 vs. 11.6 months; p = 0.006).

CONCLUSION: The use of chemotherapy was associated with a survival benefit only for ICC patients with nodal metastasis, advanced tumor stage, or an inadequate surgical resection. Chemotherapy for resected ICC should be strongly considered for tumors harboring high-risk features.

Author List

Miura JT, Johnston FM, Tsai S, George B, Thomas J, Eastwood D, Banerjee A, Christians KK, Turaga KK, Pawlik TM, Clark Gamblin T

Authors

Anjishnu Banerjee PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Associate Professor in the Medicine department at Medical College of Wisconsin
James P. Thomas MD, PhD Professor in the Medicine department at Medical College of Wisconsin
Susan Tsai MD Professor in the Surgery department at Medical College of Wisconsin




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

Aged
Antineoplastic Agents
Bile Duct Neoplasms
Bile Ducts, Intrahepatic
Chemotherapy, Adjuvant
Cholangiocarcinoma
Female
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Neoplasm, Residual
Survival Rate