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. 2020 Apr;9(8):2674-2685.
doi: 10.1002/cam4.2925. Epub 2020 Feb 19.

Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

Lei Wang  1 , Manjun Deng  2 , Qiao Ke  2 , Jianying Lou  3 , Shuguo Zheng  4 , Xinyu Bi  5 , Jianming Wang  6 , Wei Guo  7 , Fuyu Li  8 , Jian Wang  9 , Yamin Zheng  10 , Jingdong Li  11 , Shi Cheng  12 , Weiping Zhou  13 , Yongyi Zeng  1   2
Affiliations

Postoperative adjuvant therapy following radical resection for intrahepatic cholangiocarcinoma: A multicenter retrospective study

Lei Wang et al. Cancer Med. 2020 Apr.

Abstract

Background and aims: The prognosis of intrahepatic cholangiocarcinoma (ICC) after radical resection is far from satisfactory; however, the clinical value of adjuvant therapy (AT) remains controversial. This multicenter study aimed to evaluate the clinical value of AT and identify potential patients who would be benefited from AT.

Methods: Data from ICC patients who underwent radical resection were retrospectively collected from 12 hepatobiliary centers in China between December 2012 and December 2015. Patients were divided into AT and non-AT groups based on whether AT was administered or not. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method before and after 1:2 propensity score matching (PSM). Subgroup analyses were conducted based on the established staging systems.

Results: A total of 412 patients were enrolled in this study, and 77 patients (18.9%) received AT, including 32 (7.8%) patients who received transarterial chemoembolization (TACE), 21 (5.1%) patients who received chemotherapy, 10 (2.4%) patients who received radiotherapy, and 14 (3.4%) patients who received adjuvant chemoradiotherapy. The median OS and DFS were both longer in the AT group than in the non-AT group (43.0 months vs 21.0 months, P = .015; 16.0 months vs 11.0 months, P = .045, respectively), and the advantage of AT was confirmed for both the OS and DFS (P = .023; P = .046, respectively) after 1:2 PSM. Furthermore, based on the established nomogram, only "middle-risk" patients receiving AT cherished a longer median OS (43.0 months vs 20.0 months, P = .033). In subgroup analyses that were stratified by different AT strategies, patients receiving postoperative chemotherapy had a longer median OS (37.0 months vs 21.0 months, P = .039), while patients receiving postoperative TACE had a longer median DFS (50.0 months vs 11.0 months, P = .007).

Conclusion: With the current data, we conclude that AT benefits ICC patients following radical resection, especially those "middle-risk" patients, as evaluated by the established nomogram. However, exactly which patients are the most suitable for AT requires further study and validation.

Keywords: adjuvant therapy; disease-free survival; intrahepatic cholangiocarcinoma; overall survival; propensity score matching.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Flow chart of patients' enrollment
Figure 2
Figure 2
Overall survival (OS) (A) and disease‐free survival (DFS) (B) of patients receiving adjuvant therapy (AT) or not in a whole cohort. OS (C) and DFS (D) of patients receiving AT or not after 1:2 propensity score matching
Figure 3
Figure 3
Forest plot of subgroup analysis stratified by risk factors
Figure 4
Figure 4
Overall survival (OS) of patients with stage Ⅰ (A), stage Ⅱ (B), and stage Ⅲ (C) according to the 8th AJCC stage system receiving adjuvant therapy (AT) or not. OS of patients with “low‐risk” (D), “middle‐risk” (E), and “high‐risk” (F) according to the established nomogram
Figure 5
Figure 5
Overall survival (OS) (A) and disease‐free survival (DFS) (B) of patients receiving adjuvant TACE, chemotherapy, radiotherapy, and chemoradiotherapy, compared with those without adjuvant therapy
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