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Which Patients With Cholangiocarcinoma May Benefit From Perioperative Chemotherapy?

By: Jenna Carter, PhD
Posted: Wednesday, September 6, 2023

Cholangiocarcinoma is typically characterized by aggressive biology, but many patients with advanced disease are amenable to surgical resection. Although resection may be curative in some cases, cancer recurrence is still observed in a large percentage of patients. An article published in the European Journal of Surgical Oncology highlighted the impact of perioperative chemotherapy on survival in patients with this type of liver cancer undergoing curative resection. Amit Mahipal, MD, of Seidman Cancer Center and Case Western Reserve University, Cleveland, and colleagues reported that perioperative chemotherapy was significantly associated with improved survival outcomes in those with adverse prognostic features (such as lymph node involvement and larger tumors).

“Prospective studies are needed to define clinicopathologic and molecular predictors of benefit from perioperative systemic therapies,” the study authors concluded.

A total of 182 patients diagnosed with cholangiocarcinoma and undergoing curative-intent resection were included in this study. Patients underwent resection at the Mayo Clinic in Rochester, Minnesota, between January 2000 and December 2019. Electronic medical records were collected and reviewed, and data on tumor characteristics, treatment, surgery, pathology, and survival were analyzed. Cox proportional hazard modeling was then used to determine the impact of perioperative chemotherapy on disease-free and overall survival.

After adjustments were made for lymph node status, tumor stage, size, grade, and resection margin, receipt of perioperative chemotherapy was significantly associated with improvement in disease-free survival (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.41–0.98; P = .04) and overall survival (HR = 0.46, 95% CI = 0.27–0.78; P < .01). However, univariate analysis revealed that poorer overall survival was associated with the involvement of regional lymph nodes (P < .01), stage III or IV disease (P = .015), grade 3 or higher histology (P = .04), tumor size more than 5 cm (P = .13), and positive surgical resection margins (P < .01). The authors created a nomogram to predict 3-year disease–free survival in patients with cholangiocarcinoma undergoing surgical resection.  

Disclosure: The study authors reported no conflicts of interest.

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