Synapse - Intrahepatic cholangiocarcinoma with lymph node metastasis: Treatment-related outcomes and the role of tumor genomics in patient selection

Intrahepatic cholangiocarcinoma with lymph node metastasis: Treatment-related outcomes and the role of tumor genomics in patient selection Journal Article

Authors:	Jolissaint, J. S.; Soares, K. C.; Seier, K. P.; Kundra, R.; Gönen, M.; Shin, P. J.; Boerner, T.; Sigel, C.; Madupuri, R.; Vakiani, E.; Cercek, A.; Harding, J. J.; Kemeny, N. E.; Connell, L. C.; Balachandran, V. P.; D’Angelica, M. I.; Drebin, J. A.; Kingham, T. P.; Wei, A. C.; Jarnagin, W. R.
Article Title:	Intrahepatic cholangiocarcinoma with lymph node metastasis: Treatment-related outcomes and the role of tumor genomics in patient selection
Abstract:	Purpose: Lymph node metastasis (LNM) drastically reduces survival after resection of intrahepatic cholangiocarcinoma (IHC). Optimal treatment is ill defined, and it is unclear whether tumor mutational profiling can support treatment decisions. Experimental Design: Patients with liver-limited IHC with or without LNM treated with resection (N 1⁄4 237), hepatic arterial infusion chemotherapy (HAIC; N 1⁄4 196), or systemic chemotherapy alone (SYS; N 1⁄4 140) at our institution between 2000 and 2018 were included. Genomic sequencing was analyzed to determine whether genetic alterations could stratify outcomes for patients with LNM. Results: For node-negative patients, resection was associated with the longest median overall survival [OS, 59.9 months; 95% confidence interval (CI), 47.2–74.31], followed by HAIC (24.9 months; 95% CI, 20.3–29.6), and SYS (13.7 months; 95% CI, 8.9–15.9; P < 0.001). There was no difference in survival for node-positive patients treated with resection (median OS, 19.7 months; 95% CI, 12.1–27.2) or HAIC (18.1 months; 95% CI, 14.1–26.6; P 1⁄4 0.560); however, survival in both groups was greater than SYS (11.2 months; 95% CI, 14.1–26.6; P 1⁄4 0.024). Node-positive patients with at least one high-risk genetic alteration (TP53 mutation, KRAS mutation, CDKN2A/B deletion) had worse survival compared to wild-type patients (median OS, 12.1 months; 95% CI, 5.7–21.5; P 1⁄4 0.002), regardless of treatment. Conversely, there was no difference in survival for node-positive patients with IDH1/2 mutations compared to wild-type patients. Conclusions: There was no difference in OS for patients with node-positive IHC treated by resection versus HAIC, and both treatments had better survival than SYS alone. The presence of high-risk genetic alterations provides valuable prognostic information that may help guide treatment. © 2021 American Association for Cancer Research.
Journal Title:	Clinical Cancer Research
Volume:	27
Issue:	14
ISSN:	1078-0432
Publisher:	American Association for Cancer Research
Date Published:	2021-07-15
Start Page:	4101
End Page:	4108
Language:	English
DOI:	10.1158/1078-0432.Ccr-21-0412
PUBMED:	33963001
PROVIDER:	scopus
PMCID:	PMC8282702
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85110071622&doi=10.1158%2f1078-0432.CCR-21-0412&partnerID=40&md5=d16de9a735e51d765f4cc23778b5e94a
Notes:	Article -- Export Date: 2 August 2021 -- Source: Scopus