Article Abstract

Adjuvant chemotherapy for intrahepatic cholangiocarcinoma: approaching clinical practice consensus?

Authors: Ariella M. Altman, Scott Kizy, Schelomo Marmor, Jane Y. C. Hui, Todd M. Tuttle, Eric H. Jensen, Jason W. Denbo


Background: Intrahepatic cholangiocarcinoma (ICC) is rare with limited evidence-based guidelines. This retrospective study evaluates the use of chemotherapy in patients with resected ICC.
Methods: The Surveillance Epidemiology and End Results (SEER) program database was used to identify patients with resected ICC. Patients were stratified by date of diagnosis (2000–2004, 2005–2009, 2010–2014), T, and N stage. Multivariable logistic regression models identified predictors of chemotherapy use. Kaplan-Meier and Cox proportional hazard models were used to identify survival trends.
Results: One thousand and two hundred twenty-three patients met inclusion criteria. Chemotherapy utilization increased over time (33% to 41%, P≤0.05). Chemotherapy use increased in lymph node (LN) positive patients (32% to 60% in 2010–2014; (P≤0.05) and T3/T4 disease (40% to 60% in 2010–2014; P≤0.01), but not in patients with LN negative or T1/T2 disease. LN positivity was associated with utilization of chemotherapy in 2005–2009 and 2010–2014. Overall survival increased from 32 to 41 months (P≤0.05). In LN positive patients, chemotherapy was associated with a decreased hazard ratio of death (P≤0.05) and T3/T4 disease was associated with an increased hazard ratio of death (P≤0.05).
Conclusions: Adjuvant chemotherapy use in ICC has increased. More LN positive or patients with T3/T4 tumors are receiving chemotherapy, which may explain the improvement in overall survival.

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