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Adjuvant Therapy Is Associated With Improved Survival in Resected Perihilar Cholangiocarcinoma: A Propensity Matched Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There are limited well-controlled studies that conclusively demonstrate a benefit of adjuvant therapy in resected perihilar cholangiocarcinoma. Most studies include all biliary tract tumors as one entity despite the heterogeneity of these diseases.

Methods

We identified patients with resected perihilar cholangiocarcinoma from the National Cancer Database between 2006 and 2013. Patients who received adjuvant therapy (AT) were compared to an observation (OB) cohort by propensity score matching.

Results

We identified 1846 patients: 1053 patients (57%) in the OB group, and 793 (43%) in the AT group. Patients who received adjuvant therapy were more likely to be younger, have a higher rate of private insurance, have higher T and N stage tumors, and were more likely to have positive resection margins. After 1:1 propensity score matching, 577 OB group patients were compared with 577 AT group patients. The AT cohort was associated with better overall survival compared with the OB cohort (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.64–0.83). The median survival was 29.5 and 23.3 months for the AT and OB groups, respectively (P < 0.01). Subgroup analysis demonstrated a survival advantage for adjuvant therapy in disease with positive resection margins (HR 0.53; 95% CI 0.42–0.67).

Conclusions

Adjuvant therapy is associated with improved survival in resected perihilar cholangiocarcinoma, especially in disease with positive resection margins. This study supports the use of adjuvant therapy in high-risk patients.

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Acknowledgments

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. RMM is the Alvin Baldwin, Jr. Chair in Surgery. MRP is the Dedman Family Scholar in clinical care. SCW is a UT Southwestern Disease-Oriented Clinical Scholar. The authors would like to thank Helen Mayo from the UT Southwestern Health Sciences Digital Library and Learning Center for assistance with literature searches, and Dave Primm for help in editing this manuscript.

Funding

The National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105.

Disclosures

All authors have no disclosures.

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Author notes

  1. Ibrahim Nassour and Ali A. Mokdad have contributed equally to this work.

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Ibrahim Nassour MD, Ali A. Mokdad MD, Matthew R. Porembka MD, Michael A. Choti MD, Patricio M. Polanco MD, John C. Mansour MD, Rebecca M. Minter MD, Sam C. Wang MD & Adam C. Yopp MD

  2. Department of Veterans Affairs, North Texas Health Care System, Dallas, TX, USA

    Patricio M. Polanco MD

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Correspondence to Adam C. Yopp MD.

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Nassour, I., Mokdad, A.A., Porembka, M.R. et al. Adjuvant Therapy Is Associated With Improved Survival in Resected Perihilar Cholangiocarcinoma: A Propensity Matched Study. Ann Surg Oncol 25, 1193–1201 (2018). https://doi.org/10.1245/s10434-018-6388-7

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