Impact of adjuvant chemotherapy on survival in patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis

Bradley N. Reames, Fabio Bagante, Aslam Ejaz, Gaya Spolverato, Andrea Ruzzenente, Matthew Weiss, Sorin Alexandrescu, Hugo P. Marques, Luca Aldrighetti, Shishir K. Maithel, Carlo Pulitano, Todd W. Bauer, Feng Shen, George A. Poultsides, Oliver Soubrane, Guillaume Martel, Bas G. Koerkamp, Alfredo Guglielmi, Endo Itaru, Timothy M. Pawlik

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Abstract

Background The benefit of adjuvant chemotherapy for resected intrahepatic cholangiocarcinoma (ICC) is unclear. The aim of the current study was to investigate the impact of adjuvant chemotherapy on survival among patients undergoing resection of ICC using a multi-institutional database. Methods 1154 ICC patients undergoing curative-intent hepatectomy between 1990 and 2015 were identified from 14 institutions. Cox proportional hazard modeling was used to determine the impact of adjuvant chemotherapy on overall survival (OS). Results Following resection, 347 (30%) patients received adjuvant chemotherapy, most commonly a gemcitabine-based regimen (n = 184, 52%). Patients with T2/T3/T4 disease were more likely to receive adjuvant therapy compared with patients with T1a/T1b disease (OR 2.5, 95%CI 1.89–3.23; P < 0.001). Among patients who did and did not receive adjuvant therapy, patients with T2/T3/T4 tumors had a 5-year OS of 37% (95%CI 28.9–44.4) versus 30% (95%CI 23.8–35.6), respectively (p = 0.006). Similarly patients with N1 disease who received adjuvant chemotherapy tended to have improved 5-year OS (18.3%, 95%CI 9.0–30.1 vs. no adjuvant therapy 12%, 95%CI 3.9–24.4; P = 0.050). Conclusions While adjuvant chemotherapy did not influence the prognosis of all ICC patients following surgical resection, it was associated with a potential survival benefit in subgroups of patients at increased risk for recurrence, such as those with advanced tumors.

Original languageEnglish (US)
Pages (from-to)901-909
Number of pages9
JournalHPB
Volume19
Issue number10
DOIs
StatePublished - Oct 2017

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Cholangiocarcinoma
Adjuvant Chemotherapy
Survival
gemcitabine
Hepatectomy
Neoplasms
Therapeutics
Databases
Recurrence

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Impact of adjuvant chemotherapy on survival in patients with intrahepatic cholangiocarcinoma : a multi-institutional analysis. / Reames, Bradley N.; Bagante, Fabio; Ejaz, Aslam; Spolverato, Gaya; Ruzzenente, Andrea; Weiss, Matthew; Alexandrescu, Sorin; Marques, Hugo P.; Aldrighetti, Luca; Maithel, Shishir K.; Pulitano, Carlo; Bauer, Todd W.; Shen, Feng; Poultsides, George A.; Soubrane, Oliver; Martel, Guillaume; Koerkamp, Bas G.; Guglielmi, Alfredo; Itaru, Endo; Pawlik, Timothy M.

In: HPB, Vol. 19, No. 10, 10.2017, p. 901-909.

Research output: Contribution to journalArticle

Reames, BN, Bagante, F, Ejaz, A, Spolverato, G, Ruzzenente, A, Weiss, M, Alexandrescu, S, Marques, HP, Aldrighetti, L, Maithel, SK, Pulitano, C, Bauer, TW, Shen, F, Poultsides, GA, Soubrane, O, Martel, G, Koerkamp, BG, Guglielmi, A, Itaru, E & Pawlik, TM 2017, 'Impact of adjuvant chemotherapy on survival in patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis', HPB, vol. 19, no. 10, pp. 901-909. https://doi.org/10.1016/j.hpb.2017.06.008
Reames, Bradley N. ; Bagante, Fabio ; Ejaz, Aslam ; Spolverato, Gaya ; Ruzzenente, Andrea ; Weiss, Matthew ; Alexandrescu, Sorin ; Marques, Hugo P. ; Aldrighetti, Luca ; Maithel, Shishir K. ; Pulitano, Carlo ; Bauer, Todd W. ; Shen, Feng ; Poultsides, George A. ; Soubrane, Oliver ; Martel, Guillaume ; Koerkamp, Bas G. ; Guglielmi, Alfredo ; Itaru, Endo ; Pawlik, Timothy M. / Impact of adjuvant chemotherapy on survival in patients with intrahepatic cholangiocarcinoma : a multi-institutional analysis. In: HPB. 2017 ; Vol. 19, No. 10. pp. 901-909.
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title = "Impact of adjuvant chemotherapy on survival in patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis",
abstract = "Background The benefit of adjuvant chemotherapy for resected intrahepatic cholangiocarcinoma (ICC) is unclear. The aim of the current study was to investigate the impact of adjuvant chemotherapy on survival among patients undergoing resection of ICC using a multi-institutional database. Methods 1154 ICC patients undergoing curative-intent hepatectomy between 1990 and 2015 were identified from 14 institutions. Cox proportional hazard modeling was used to determine the impact of adjuvant chemotherapy on overall survival (OS). Results Following resection, 347 (30{\%}) patients received adjuvant chemotherapy, most commonly a gemcitabine-based regimen (n = 184, 52{\%}). Patients with T2/T3/T4 disease were more likely to receive adjuvant therapy compared with patients with T1a/T1b disease (OR 2.5, 95{\%}CI 1.89–3.23; P < 0.001). Among patients who did and did not receive adjuvant therapy, patients with T2/T3/T4 tumors had a 5-year OS of 37{\%} (95{\%}CI 28.9–44.4) versus 30{\%} (95{\%}CI 23.8–35.6), respectively (p = 0.006). Similarly patients with N1 disease who received adjuvant chemotherapy tended to have improved 5-year OS (18.3{\%}, 95{\%}CI 9.0–30.1 vs. no adjuvant therapy 12{\%}, 95{\%}CI 3.9–24.4; P = 0.050). Conclusions While adjuvant chemotherapy did not influence the prognosis of all ICC patients following surgical resection, it was associated with a potential survival benefit in subgroups of patients at increased risk for recurrence, such as those with advanced tumors.",
author = "Reames, {Bradley N.} and Fabio Bagante and Aslam Ejaz and Gaya Spolverato and Andrea Ruzzenente and Matthew Weiss and Sorin Alexandrescu and Marques, {Hugo P.} and Luca Aldrighetti and Maithel, {Shishir K.} and Carlo Pulitano and Bauer, {Todd W.} and Feng Shen and Poultsides, {George A.} and Oliver Soubrane and Guillaume Martel and Koerkamp, {Bas G.} and Alfredo Guglielmi and Endo Itaru and Pawlik, {Timothy M.}",
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T1 - Impact of adjuvant chemotherapy on survival in patients with intrahepatic cholangiocarcinoma

T2 - a multi-institutional analysis

AU - Reames, Bradley N.

AU - Bagante, Fabio

AU - Ejaz, Aslam

AU - Spolverato, Gaya

AU - Ruzzenente, Andrea

AU - Weiss, Matthew

AU - Alexandrescu, Sorin

AU - Marques, Hugo P.

AU - Aldrighetti, Luca

AU - Maithel, Shishir K.

AU - Pulitano, Carlo

AU - Bauer, Todd W.

AU - Shen, Feng

AU - Poultsides, George A.

AU - Soubrane, Oliver

AU - Martel, Guillaume

AU - Koerkamp, Bas G.

AU - Guglielmi, Alfredo

AU - Itaru, Endo

AU - Pawlik, Timothy M.

PY - 2017/10

Y1 - 2017/10

N2 - Background The benefit of adjuvant chemotherapy for resected intrahepatic cholangiocarcinoma (ICC) is unclear. The aim of the current study was to investigate the impact of adjuvant chemotherapy on survival among patients undergoing resection of ICC using a multi-institutional database. Methods 1154 ICC patients undergoing curative-intent hepatectomy between 1990 and 2015 were identified from 14 institutions. Cox proportional hazard modeling was used to determine the impact of adjuvant chemotherapy on overall survival (OS). Results Following resection, 347 (30%) patients received adjuvant chemotherapy, most commonly a gemcitabine-based regimen (n = 184, 52%). Patients with T2/T3/T4 disease were more likely to receive adjuvant therapy compared with patients with T1a/T1b disease (OR 2.5, 95%CI 1.89–3.23; P < 0.001). Among patients who did and did not receive adjuvant therapy, patients with T2/T3/T4 tumors had a 5-year OS of 37% (95%CI 28.9–44.4) versus 30% (95%CI 23.8–35.6), respectively (p = 0.006). Similarly patients with N1 disease who received adjuvant chemotherapy tended to have improved 5-year OS (18.3%, 95%CI 9.0–30.1 vs. no adjuvant therapy 12%, 95%CI 3.9–24.4; P = 0.050). Conclusions While adjuvant chemotherapy did not influence the prognosis of all ICC patients following surgical resection, it was associated with a potential survival benefit in subgroups of patients at increased risk for recurrence, such as those with advanced tumors.

AB - Background The benefit of adjuvant chemotherapy for resected intrahepatic cholangiocarcinoma (ICC) is unclear. The aim of the current study was to investigate the impact of adjuvant chemotherapy on survival among patients undergoing resection of ICC using a multi-institutional database. Methods 1154 ICC patients undergoing curative-intent hepatectomy between 1990 and 2015 were identified from 14 institutions. Cox proportional hazard modeling was used to determine the impact of adjuvant chemotherapy on overall survival (OS). Results Following resection, 347 (30%) patients received adjuvant chemotherapy, most commonly a gemcitabine-based regimen (n = 184, 52%). Patients with T2/T3/T4 disease were more likely to receive adjuvant therapy compared with patients with T1a/T1b disease (OR 2.5, 95%CI 1.89–3.23; P < 0.001). Among patients who did and did not receive adjuvant therapy, patients with T2/T3/T4 tumors had a 5-year OS of 37% (95%CI 28.9–44.4) versus 30% (95%CI 23.8–35.6), respectively (p = 0.006). Similarly patients with N1 disease who received adjuvant chemotherapy tended to have improved 5-year OS (18.3%, 95%CI 9.0–30.1 vs. no adjuvant therapy 12%, 95%CI 3.9–24.4; P = 0.050). Conclusions While adjuvant chemotherapy did not influence the prognosis of all ICC patients following surgical resection, it was associated with a potential survival benefit in subgroups of patients at increased risk for recurrence, such as those with advanced tumors.

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