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01-04-2021 | Cholangiocarcinoma | Hepatobiliary Tumors

Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?

Authors: Diamantis I. Tsilimigras, MD, J. Madison Hyer, MS, Anghela Z. Paredes, MD, MPH, Dimitrios Moris, MD, PhD, Kota Sahara, MD, Alfredo Guglielmi, MD, Luca Aldrighetti, MD, Matthew Weiss, MD, Todd W. Bauer, MD, Sorin Alexandrescu, MD, George A. Poultsides, MD, Shishir K. Maithel, MD, Hugo P. Marques, MD, Guillaume Martel, MD, Carlo Pulitano, MD, Feng Shen, MD, Olivier Soubrane, MD, Bas Groot Koerkamp, MD, Itaru Endo, MD, PhD, Kazunari Sasaki, MD, Federico Aucejo, MD, Xu-Feng Zhang, MD, Timothy M. Pawlik, MD, MPH, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 4/2021

Abstract

Introduction

While tumor burden (TB) has been associated with outcomes among patients with hepatocellular carcinoma, the role of overall TB in intrahepatic cholangiocarcinoma (ICC) remains poorly defined.

Methods

Patients undergoing curative-intent resection of ICC between 2000 and 2017 were identified from a multi-institutional database. The impact of TB on overall (OS) and disease-free survival (DFS) was evaluated in the multi-institutional database and validated externally.

Results

Among 1101 patients who underwent curative-intent resection of ICC, 624 (56.7%) had low TB, 346 (31.4%) medium TB, and 131 (11.9%) high TB. OS incrementally worsened with higher TB (5-year OS; low TB: 48.3% vs medium TB: 29.8% vs high TB: 17.3%, p < 0.001). Similarly, patients with low TB had better DFS compared with medium and high TB patients (5-year DFS: 38.3% vs 18.7% vs 6.9%, p < 0.001). On multivariable analysis, TB was independently associated with OS (medium TB: HR = 1.40, 95% CI 1.14–1.71; high TB: HR = 1.89, 95% CI 1.46–2.45) and DFS (medium TB, HR = 1.61, 95% CI 1.33–1.96; high TB: HR = 2.03, 95% CI 1.56–2.64). Survival analysis revealed an excellent prognostic discrimination using the TB among the external validation cohort (3-year OS; low TB: 44.8%, medium TB: 29.3%; high TB: 23.3%, p = 0.03; 3-year DFS: low TB: 32.7%, medium TB: 10.7%; high TB: 0%, p < 0.001). While neoadjuvant chemotherapy was not associated with survival across the TB groups, receipt of adjuvant chemotherapy was associated with increased survival among patients with high TB (5-year OS: 24.4% vs 13.4%, p = 0.02).

Conclusion

Overall TB dictated prognosis among patients with resectable ICC. TB may be used as a tool to help guide post-resection treatment strategies.

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Title: Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
Authors: Diamantis I. Tsilimigras, MD
J. Madison Hyer, MS
Anghela Z. Paredes, MD, MPH
Dimitrios Moris, MD, PhD
Kota Sahara, MD
Alfredo Guglielmi, MD
Luca Aldrighetti, MD
Matthew Weiss, MD
Todd W. Bauer, MD
Sorin Alexandrescu, MD
George A. Poultsides, MD
Shishir K. Maithel, MD
Hugo P. Marques, MD
Guillaume Martel, MD
Carlo Pulitano, MD
Feng Shen, MD
Olivier Soubrane, MD
Bas Groot Koerkamp, MD
Itaru Endo, MD, PhD
Kazunari Sasaki, MD
Federico Aucejo, MD
Xu-Feng Zhang, MD
Timothy M. Pawlik, MD, MPH, PhD, FACS
Publication date: 01-04-2021
Publisher: Springer International Publishing
Keywords: Cholangiocarcinoma
Cholangiocarcinoma
Cytostatic Therapy
Published in: Annals of Surgical Oncology / Issue 4/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-020-09393-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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