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Background <p>Randomized data suggest improved survival with adjuvant chemotherapy for biliary tract cancers; however, subset analyses of intrahepatic cholangiocarcinoma (IHC) show limited survival benefit. This study evaluated the impact of adjuvant chemotherapy on recurrence patterns and overall survival (OS) in patients with resected IHC.</p> Methods <p>Patients who underwent curative-intent resection for IHC were identified within a bi-institutional dataset and the National Cancer Database (NCDB). Patients were stratified by receipt of adjuvant chemotherapy. Site of first recurrence was categorized as liver only, regional, distant, or multifocal. Survival outcomes within each dataset were compared using Kaplan–Meier methods.</p> Results <p>In the bi-institutional dataset, 347 patients underwent resection for IHC, and 149 (43%) patients received adjuvant cytotoxic chemotherapy. Recurrence was observed in 222 (64.0%) patients. OS was similar between groups (adjuvant vs. observation: 42 vs. 49&#xa0;months; <i>p</i>&#xa0;=&#xa0;0.13), and did not differ in patients who received capecitabine specifically (<i>p</i>&#xa0;=&#xa0;0.09) or in a risk-adjusted multivariable analysis. Recurrence-free survival was worse in those who received adjuvant chemotherapy (<i>p</i>&#xa0;=&#xa0;0.04), although the liver was the most common site of recurrence in both groups (0.63). A similar analysis of 1159 resected IHCs from the NCDB also demonstrated no association between adjuvant chemotherapy and OS (49&#xa0;vs. 57&#xa0;months; <i>p</i>&#xa0;=&#xa0;0.1).</p> Conclusion <p>Adjuvant chemotherapy may not be associated with improved OS in IHC and did not have an impact on hepatic recurrence in this retrospective analysis. Future investigation to identify more effective adjuvant systemic regimens and/or explore the potential role of adjuvant liver-directed therapies to reduce hepatic recurrence that may improve OS for IHC is warranted.</p>

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Adjuvant Cytotoxic Chemotherapy may not be Associated with a Survival Advantage for Resected Intrahepatic Cholangiocarcinoma

  • 期刊论文

  • 发表日期：

    2025年1月18日

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  • Jeremy Sharib,
  • Kristen E. Rhodin,
  • Annie Liu,
  • Sarah McIntyre,
  • Alex Bartholomew,
  • Sabran Masoud,
  • Isabel DeLaura,
  • Nancy E. Kemeny,
  • Andrea Cercek,
  • James J. Harding,
  • Eileen M. O’Reilly,
  • Ghassan K. Abou-Alfa,
  • Diane Reidy-Lagunes,
  • Louise Catherine Connell,
  • Imane El Dika,
  • Vinod P. Balachandran,
  • Jeffrey Drebin,
  • Kevin C. Soares,
  • Alice C. Wei,
  • T. Peter Kingham,
  • Michael I. D’Angelica,
  • Hope Uronis,
  • John Strickler,
  • S. David Hsu,
  • Michael Morse,
  • Sabino Zani,
  • Peter J. Allen,
  • William R. Jarnagin,
  • Michael E. Lidsky

摘要

Background

Randomized data suggest improved survival with adjuvant chemotherapy for biliary tract cancers; however, subset analyses of intrahepatic cholangiocarcinoma (IHC) show limited survival benefit. This study evaluated the impact of adjuvant chemotherapy on recurrence patterns and overall survival (OS) in patients with resected IHC.

Methods

Patients who underwent curative-intent resection for IHC were identified within a bi-institutional dataset and the National Cancer Database (NCDB). Patients were stratified by receipt of adjuvant chemotherapy. Site of first recurrence was categorized as liver only, regional, distant, or multifocal. Survival outcomes within each dataset were compared using Kaplan–Meier methods.

Results

In the bi-institutional dataset, 347 patients underwent resection for IHC, and 149 (43%) patients received adjuvant cytotoxic chemotherapy. Recurrence was observed in 222 (64.0%) patients. OS was similar between groups (adjuvant vs. observation: 42 vs. 49 months; p = 0.13), and did not differ in patients who received capecitabine specifically (p = 0.09) or in a risk-adjusted multivariable analysis. Recurrence-free survival was worse in those who received adjuvant chemotherapy (p = 0.04), although the liver was the most common site of recurrence in both groups (0.63). A similar analysis of 1159 resected IHCs from the NCDB also demonstrated no association between adjuvant chemotherapy and OS (49 vs. 57 months; p = 0.1).

Conclusion

Adjuvant chemotherapy may not be associated with improved OS in IHC and did not have an impact on hepatic recurrence in this retrospective analysis. Future investigation to identify more effective adjuvant systemic regimens and/or explore the potential role of adjuvant liver-directed therapies to reduce hepatic recurrence that may improve OS for IHC is warranted.