Synapse - Hepatic disease control in patients with intrahepatic cholangiocarcinoma correlates with overall survival

Hepatic disease control in patients with intrahepatic cholangiocarcinoma correlates with overall survival Journal Article

Authors:	Soares, K. C.; Jolissaint, J. S.; McIntyre, S. M.; Seier, K. P.; Gönen, M.; Sigel, C.; Nasar, N.; Cercek, A.; Harding, J. J.; Kemeny, N. E.; Connell, L. C.; Koerkamp, B. G.; Balachandran, V. P.; D'Angelica, M. I.; Drebin, J. A.; Kingham, T. P.; Wei, A. C.; Jarnagin, W. R.
Article Title:	Hepatic disease control in patients with intrahepatic cholangiocarcinoma correlates with overall survival
Abstract:	Purpose: The role of locoregional therapy compared to systemic chemotherapy (SYS) for unresectable intrahepatic cholangiocarcinoma (IHC) remains controversial. The importance of hepatic disease control, either as initial or salvage therapy, is also unclear. We compared overall survival (OS) in patients treated with resection, hepatic arterial infusion pump (HAIP) chemotherapy, or SYS as it relates to hepatic recurrence or progression. We also evaluated recurrence after resection to determine the efficacy of locoregional salvage therapy. Patients and Methods: In this single-institution retrospective analysis, patients with biopsy-proven IHC treated with either curative-intent resection, HAIP (with or without SYS), or SYS alone were analyzed. Propensity score matching (PSM) was used to compare patients with liver-limited, advanced disease treated with HAIP versus SYS. The impact of locoregional salvage therapies in patients with liver-limited recurrence was analyzed in the resection cohort. Results: From 2000 to 2017, 714 patients with IHC were treated, 219 (30.7%) with resectable disease, 316 (44.3%) with locally advanced disease, and 179 (25.1%) with metastatic disease. Resected patients were less likely to recur or progress in the liver (hazard ratio [HR] 0.41, 95% CI 0.34–0.45) versus those that received HAIP or SYS (HR 0.58, 95% CI 0.50–0.65 vs. HR 0.63, 95% CI 0.57–0.69, respectively). In resected patients, 161 (64.4%) recurred, with 65 liver-only recurrences. Thirty of these patients received subsequent locoregional therapy. On multivariable analysis, locoregional therapy was associated with improved OS after isolated liver recurrence (HR 0.46, 95% CI 0.29–0.75; p = 0.002). In patients with locally advanced unresectable or multifocal liver disease (with or without distant organ metastases), PSM demonstrated improved hepatic progression-free survival in patients treated with HAIP versus SYS (HR 0.65; 95% CI 0.46–0.91; p = 0.01), which correlated with improved OS (HR 0.59, 95% CI 0.43–0.80; p < 0.001). Conclusion: In patients with liver-limited IHC, hepatic disease control is associated with improved OS, emphasizing the potential importance of liver-directed therapy. © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Keywords:	cholangiocarcinoma; regional chemotherapy; bile duct cancer; locoregional therapy; biliary neoplasm; hepatic artery pump
Journal Title:	Cancer Medicine
Volume:	12
Issue:	11
ISSN:	2045-7634
Publisher:	Wiley Blackwell
Date Published:	2023-06-01
Start Page:	12272
End Page:	12284
Language:	English
DOI:	10.1002/cam4.5925
PUBMED:	37062071
PROVIDER:	scopus
PMCID:	PMC10278501
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85152910489&doi=10.1002%2fcam4.5925&partnerID=40&md5=12c67dd243c13c8aa1f95d4c7240e6d0
Notes:	Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is William Jarnagin -- Source: Scopus