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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2015

01-10-2015 | Hepatobiliary Tumors

Chemotherapy for Surgically Resected Intrahepatic Cholangiocarcinoma

Authors: John T. Miura, MD, Fabian M. Johnston, MD, MHS, Susan Tsai, MD, MHS, Ben George, MD, Jim Thomas, MD, Dan Eastwood, MS, Anjishnu Banerjee, PhD, Kathleen K. Christians, MD, Kiran K. Turaga, MD, MPH, Timothy M. Pawlik, MD, MPH, PhD, FACS, T. Clark Gamblin, MD, MS

Published in: Annals of Surgical Oncology | Issue 11/2015

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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.
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Metadata
Title
Chemotherapy for Surgically Resected Intrahepatic Cholangiocarcinoma
Authors
John T. Miura, MD
Fabian M. Johnston, MD, MHS
Susan Tsai, MD, MHS
Ben George, MD
Jim Thomas, MD
Dan Eastwood, MS
Anjishnu Banerjee, PhD
Kathleen K. Christians, MD
Kiran K. Turaga, MD, MPH
Timothy M. Pawlik, MD, MPH, PhD, FACS
T. Clark Gamblin, MD, MS
Publication date
01-10-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 11/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4501-8

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