Outcomes of adjuvant treatments for resectable intrahepatic cholangiocarcinoma: Chemotherapy alone, sequential chemoradiotherapy, or concurrent chemoradiotherapy

Yen-Kuang Lin; Mao-Chih Hsieh; Wei-Wei Wang; Yi-Chun Lin; Wei-Wen Chang; Chia-Lun Chang; Yun-Feng Cheng; Szu-Yuan Wu

doi:10.1016/j.radonc.2018.05.011

Outcomes of adjuvant treatments for resectable intrahepatic cholangiocarcinoma: Chemotherapy alone, sequential chemoradiotherapy, or concurrent chemoradiotherapy

Radiother Oncol. 2018 Sep;128(3):575-583. doi: 10.1016/j.radonc.2018.05.011. Epub 2018 May 22.

Authors

Yen-Kuang Lin¹, Mao-Chih Hsieh², Wei-Wei Wang³, Yi-Chun Lin¹, Wei-Wen Chang², Chia-Lun Chang⁴, Yun-Feng Cheng⁵, Szu-Yuan Wu⁶

Affiliations

¹ Biostatistics Center and School of Public Health, Taipei Medical University, Taiwan.
² Department of General Surgery, Wan Fang Hospital, Taipei Medical University, Taiwan.
³ Institute of Education of Economy Research, University of International Business and Economics, Beijing, China.
⁴ Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taiwan.
⁵ Department of Hematology, Zhongshan Hospital Fudan University, Shanghai, China; Department of Hematology, Zhongshan Hospital Qingpu Branch, Fudan Universiy, Shanghai, China; Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Clinical Bioinformatics, Fudan University Center for Clinical Bioinformatics, China.
⁶ Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan. Electronic address: szuyuanwu5399@gmail.com.

PMID: 29801723
DOI: 10.1016/j.radonc.2018.05.011

Abstract

Background: Prospective randomized trials have not been used to evaluate the efficacy of adjuvant therapies after intrahepatic cholangiocarcinoma (ICC) resection.

Methods: We analyzed data from the Taiwan Cancer Registry database of ICC patients receiving resection. To compare outcomes, patients with ICC were enrolled and categorized into the following adjuvant treatment modality groups: group 1, concurrent chemoradiotherapy (CCRT); group 2, sequential chemotherapy (CT) and radiotherapy (RT); and group 3, CT alone.

Results: We enrolled 599 patients with resectable ICC who received surgery without distant metastasis. Of these patients, 174 received adjuvant CCRT (group 1), 146 received adjuvant sequential CT and RT (group 2), and 279 received adjuvant CT alone (group 3). Multivariate Cox regression analysis indicated that pathologic stage and positive margin were significantly poor independent predictors. After adjustment for confounders, adjusted hazard ratios (95% confidence intervals) for overall mortality at advanced pathologic stages III and IV were 0.55 (0.41-0.74) and 0.92 (0.70-1.33) in groups 1 and 2, respectively, compared with group 3.

Conclusions: Adjuvant CCRT improved survival in resected ICC with advanced pathologic stages or a positive margin in early pathologic stages compared with adjuvant CT alone or adjuvant sequential CT and RT.

Keywords: Adjuvant chemotherapy alone; Adjuvant sequential chemoradiotherapy; Concurrent chemoradiotherapy; Intrahepatic cholangiocarcinoma; Survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Bile Duct Neoplasms / mortality
Bile Duct Neoplasms / therapy*
Chemoradiotherapy*
Cholangiocarcinoma / mortality
Cholangiocarcinoma / therapy*
Female
Humans
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Treatment Outcome