Synapse - Has management of intrahepatic cholangiocarcinoma evolved with the evidence? Trends and practice patterns from the National Cancer Database

Has management of intrahepatic cholangiocarcinoma evolved with the evidence? Trends and practice patterns from the National Cancer Database Journal Article

Authors:	Schleimer, L. E.; Kalvin, H. L.; Ellis, R. J.; Kingham, T. P.; Soares, K. C.; D’Angelica, M. I.; Balachandran, V. P.; Drebin, J.; Cercek, A.; Abou-Alfa, G. K.; O’Reilly, E. M.; Harding, J. J.; Gönen, M.; Wei, A. C.; Jarnagin, W. R.
Article Title:	Has management of intrahepatic cholangiocarcinoma evolved with the evidence? Trends and practice patterns from the National Cancer Database
Abstract:	Background: Management of intrahepatic cholangiocarcinoma (IHC) has advanced in recent decades, including randomized trial evidence supporting systemic therapy in the palliative and adjuvant setting. Mounting observational evidence suggests resection of IHC with multifocal disease (IHC-MF) or lymph node metastasis (IHC-LNM) should be limited. It is unknown how real-world practice has evolved in light of research advances. This study characterizes trends in management and outcomes of IHC without distant metastasis. Methods: We queried the National Cancer Database (NCDB) for patients treated for IHC without distant metastasis (M0) and identified subgroups with lymph node (cN1) or multifocal hepatic involvement (cT2b). Two-sided Cochran-Armitage tests evaluated trends in initial treating modality and perioperative chemotherapy. Logistic regression evaluated associations with choice of initial treating modality. Overall survival (OS) was evaluated by using Kaplan-Meier methods. Results: Between 2004 and 2020, 11,368 patients were treated for IHC without extrahepatic metastasis. Forty-three percent underwent resection. Initial management shifted from resection towards radiation or systemic therapy in IHC-MF and IHC-LNM. Use of perioperative chemotherapy increased from 39% pre-2010 to 70% in 2018–2020 (p < 0.001), most often delivered postoperatively. Across the entire cohort, median OS improved from 16 (95% confidence interval [CI] 15–18) to 27 months (95% CI 26–29). More modest improvements were observed in IHC-MF and IHC-LNM. Conclusions: Use of perioperative chemotherapy has been widely adopted, predating randomized trial evidence in the adjuvant setting. Initial management of IHC-MF and IHC-LNM has shifted from resection to systemic and/or radiation therapy. While OS has improved overall, outcomes of IHC-MF and IHC-LNM remain poor, warranting further investigation. © Society of Surgical Oncology 2024.
Keywords:	adult; clinical article; controlled study; aged; middle aged; survival rate; overall survival; multimodality cancer therapy; patient selection; systemic therapy; cancer radiotherapy; comparative study; combined modality therapy; cancer staging; follow up; follow-up studies; lymph node metastasis; antineoplastic agent; lymphatic metastasis; clinical practice; tumor volume; cohort analysis; pathology; distant metastasis; adjuvant chemotherapy; surgery; surgical mortality; liver surgery; hepatectomy; intrahepatic cholangiocarcinoma; bile duct carcinoma; bile duct neoplasms; cholangiocarcinoma; disease management; decision making; factual database; databases, factual; therapy; radioisotope therapy; bile duct tumor; intrahepatic bile duct; yttrium 90; preoperative chemotherapy; humans; prognosis; human; male; female; article; practice patterns, physicians'
Journal Title:	Annals of Surgical Oncology
Volume:	31
Issue:	10
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2024-10-01
Start Page:	6551
End Page:	6563
Language:	English
PUBMED:	39042229
PROVIDER:	scopus
DOI:	10.1245/s10434-024-15724-9
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85199347372&doi=10.1245%2fs10434-024-15724-9&partnerID=40&md5=651cd442e42893e4cb694559c39cb857
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: W. R. Jarnagin -- Source: Scopus