Neoadjuvant therapy use and association with postoperative outcomes and overall survival in patients with extrahepatic cholangiocarcinoma Journal Article
| Authors: | Silver, C. M.; Joung, R. H.; Logan, C. D.; Benson, A. B.; Mahalingam, D.; D'Angelica, M. I.; Bentrem, D. J.; Yang, A. D.; Bilimoria, K. Y.; Merkow, R. P. |
| Article Title: | Neoadjuvant therapy use and association with postoperative outcomes and overall survival in patients with extrahepatic cholangiocarcinoma |
| Abstract: | Background and Objectives: Evidence for neoadjuvant therapy (NAT) in extrahepatic cholangiocarcinoma (eCCA) is limited. Our objectives were to: (1) characterize treatment trends, (2) identify factors associated with receipt of NAT, and (3) evaluate associations between NAT and postoperative outcomes. Methods: Retrospective cohort study of the National Cancer Database (2004–2017). Multivariable logistic regression assessed associations between NAT and postoperative outcomes. Stratified analysis evaluated differences between surgery first, neoadjuvant chemotherapy, and neoadjuvant chemoradiation (CRT). Results: Among 8040 patients, 417 (5.2%) received NAT. NAT increased during the study period 2.9%–8.4% (p < 0.001). Factors associated with receipt of NAT included age <50 (vs. >75, odds ratio [OR] 4.32, p < 0.001) and stage 3 disease (vs. 1, OR 1.68, p = 0.01). Compared with surgery first, patients who received NAT had higher odds of R0 resection (OR 1.49, p = 0.01) and lower 30-day mortality (OR 0.51, p = 0.04). On stratified analysis, neoadjuvant chemotherapy was not associated with differences in any outcomes. However, neoadjuvant CRT was associated with improvement in R0 resection (OR 3.52, <0.001) and median survival (47.8 vs. 25.3 months, log-rank < 0.001) compared to surgery first. Conclusions: NAT, particularly neoadjuvant CRT, was associated with improved postoperative outcomes. These data suggest expanding the use of neoadjuvant CRT for eCCA. © 2022 Wiley Periodicals LLC. |
| Keywords: | adult; cancer survival; controlled study; aged; survival analysis; cancer surgery; retrospective studies; major clinical study; overall survival; cancer patient; comparative study; postoperative care; neoadjuvant therapy; pancreatic neoplasms; cancer staging; treatment indication; disease association; clinical assessment; cohort analysis; pathology; data base; retrospective study; pancreas tumor; clinical evaluation; long term care; bile duct carcinoma; bile duct neoplasms; bile ducts, intrahepatic; cholangiocarcinoma; hospital readmission; neoadjuvant chemotherapy; logistic regression analysis; bile duct cancer; clinical outcome; intrahepatic bile duct; mortality rate; neoadjuvant chemoradiotherapy; extrahepatic cholangiocarcinoma; neoadjuvant chemoradiation; humans; human; male; female; article; management trends; n-acetyltalosaminuronic acid |
| Journal Title: | Journal of Surgical Oncology |
| Volume: | 127 |
| Issue: | 1 |
| ISSN: | 0022-4790 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2023-01-01 |
| Start Page: | 90 |
| End Page: | 98 |
| Language: | English |
| DOI: | 10.1002/jso.27112 |
| PUBMED: | 36194064 |
| PROVIDER: | scopus |
| PMCID: | PMC9729397 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
