Non-surgical management of patients with intrahepatic cholangiocarcinoma in the United States, 2004–2015: an NCDB analysis

Kolarich, A.; Shah, Jessica; George, Thomas J.; Hughes, Steven J.; Shaw, Christiana; Geller, Brian; Grajo, Joseph R.

doi:10.21037/jgo.2018.02.04

Cited by 25 publications

(23 citation statements)

References 17 publications

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“…In addition, after examining outcomes stratified by stage, RFA provided a survival benefit only among patients with stage I ICC (ie, solitary ICC without vascular invasion), whereas outcomes were comparable among stage II patients. This is in line with previous studies, which showed a benefit for RFA only among patients with stage I ICC . Of note, high‐dose, conformal external beam radiation therapy has recently emerged as an acceptable alternative for unresectable ICC, as it may achieve local recurrence rates similar to that of ablation especially for tumors <5 cm .…”

Section: Discussionsupporting

confidence: 90%

“…This is in line with previous studies, which showed a benefit for RFA only among patients with stage I ICC. 29 Of note, high-dose, conformal external beam radiation therapy has recently emerged as an acceptable alternative for unresectable ICC, as it may achieve local recurrence rates similar to that of ablation especially for tumors <5 cm. 30 In a retrospective study of 79 patients with localized unresectable ICC, high dose (35-100 Gy) conformal external beam radiotherapy offered a median OS of 30 months, 31 whereas in a multi-institutional phase II study of 37 patients, proton-beam therapy was associated with a median and 2…”

Section: Survival Analysismentioning

confidence: 99%

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Potential survival benefit of radiofrequency ablation for small solitary intrahepatic cholangiocarcinoma in nonsurgically managed patients: A population‐based analysis

Tsilimigras

Farooq

et al. 2019

Journal of Surgical Oncology

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Background Little data regarding the selection of nonsurgical therapies for localized intrahepatic cholangiocarcinoma (ICC) are available. Methods A cohort of nonsurgically managed patients with American Joint Commission on Cancer clinical stage I/II ICC in the United States from 2004 to 2013 were identified in the National Cancer Database. Overall survival (OS) was compared according to treatment options (radiofrequency ablation [RFA] vs chemoradiotherapy) using propensity‐score matching. Results Among 505 patients, 86 patients were treated with RFA and 419 patients were treated with chemoradiotherapy. After propensity matching (n = 84, each group), 5‐year OS was 17.6% among patients who underwent RFA vs 3.8% among patients receiving chemoradiotherapy (P < .001). On bivariate analysis, RFA was related to an OS benefit (hazard ratio, 0.46; 95% confidence interval, 0.33‐0.66; P < .001). Specifially, a stage‐specific subgroup analysis revealed a survival benefit in favor of RFA among stage I patients (5‐year OS; RFA: 20.1% vs chemoradiotherapy: 3.7%, P < .001), whereas no difference in OS was noted among patients with stage II disease. Conclusion Among ICC patients with small (≤5 cm), solitary ICC without vascular invasion, RFA was associated with better survival compared with chemoradiotherapy.

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Section: Discussionsupporting

confidence: 90%

Section: Survival Analysismentioning

confidence: 99%

Potential survival benefit of radiofrequency ablation for small solitary intrahepatic cholangiocarcinoma in nonsurgically managed patients: A population‐based analysis

Tsilimigras

Farooq

et al. 2019

Journal of Surgical Oncology

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“…64 A retrospective evaluation of the treatment strategies in 6,140 ICC patients diagnosed in the United States between 2004 and 2015 showed that only 29% of these patients were surgical candidates, and RFA was the only treatment strategy in the remaining patients with stage I tumors resulting in an improvement in patient survival. 65 In the cohorts undergoing surgical resection, the tumors recurred in the majority of patients despite potentially curative R0 resection. [66][67][68][69][70][71][72] In unresectable patients, the preferred chemotherapeutic regimen is a combination of gemcitabine and cisplatin, which has been shown to reach a median progression-free survival of 8 months.…”

Section: Intrahepatic Cholangiocellular Carcinomamentioning

confidence: 99%

Ablation in Primary Liver Tumors

2019

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Minimal invasive thermal ablation techniques have a key role in the treatment regimen of primary liver tumors. These relatively low-risk procedures are established in nonresectable liver tumors and even challenge the surgical approach, which is regarded as first-line treatment in eligible patients.The location and size of the liver tumor, the applied ablation, and guidance technique are crucial for treatment outcome. The confirmation of an adequate ablation zone including sufficient tumor overlap and a safety margin (A0 ablation analogous to R0 resection) is crucial to minimize local recurrence rates and improve survival. A variety of different ablation devices is available. The outcome of conventional computed tomography- or ultrasound-guided thermal ablation in small lesions is well comparable to surgery. However, in liver lesions with large diameter overlapping ablation zones are required to ensure an adequate ablation margin. Therefore, stereotactic techniques in combination with a multiple needle approach, three-dimensional trajectory planning, and image fusion for intraoperative treatment evaluation have been successfully introduced.

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“…[1] Liver resection (LR) is the mainstay treatment with curative intent for ICC and is associated with improved long-term survival in selected patients. [1][2][3][4] However, the prognosis after LR for ICC remains poor, and risk factors related to survival after LR have not been clearly elucidated. [5][6][7][8] For patients with hepatocellular carcinoma (HCC), liver cirrhosis (usually resulted from hepatitis B or C viral infection) has been shown to be one of the risk factors associated with poor prognosis after LR.…”

Section: Introductionmentioning

confidence: 99%

Association of liver cirrhosis with the prognosis of patients with intrahepatic cholangiocarcinoma: a SEER-based cohort study

Zhang

2020

Preprint

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Background The association of liver cirrhosis with the prognosis of intrahepatic cholangiocarcinoma (ICC) remains controversial. We aimed to evaluate the relationship between liver cirrhosis (fibrosis score) and the long-term prognosis of patients with ICC. Methods SEER 18 registry from 2004 to 2015 was queried for this study. Propensity score matching (PSM) was performed to eliminate possible bias. In addition, multivariable analysis was utilized to adjust for potential confounders. The interaction test was performed to explore the impact of each stratified factor on the relationship between FS and patient survival. Overall survival (OS) and disease-specific survival (DSS) were the major endpoints. Results During the study period, 359 patients (66.5%) with lower fibrosis score (LFS; F0-4) and 181 patients (33.5%) with higher fibrosis score (HFS; F5-6) were enrolled. In the multivariable adjusted cohort (OS: n = 540; DSS: n = 417), patients with HFS had worse OS (HR, 1.43; 95% CI, 1.10 to 1.85; P = 0.007) and DSS (HR, 1.46; 95% CI, 1.08 to 1.97; P = 0.013) compared to patients with LFS. In the propensity-matched cohort, patients with HFS still had worse OS (HR, 1.50; 95% CI, 1.08 to 2.09; P = 0.016) and DSS (HR, 1.54; 95% CI, 1.05 to 2.26; P = 0.026) compared to patients with LFS. In multivariable analyses stratified by clinicopathologic features, patients with HFS were found to have significantly worse OS and DSS compared to those with LFS across all the subgroups. Conclusion Our outcomes indicated that fibrosis score is an independent risk factor for both overall and tumor-specific survival of ICC patients.

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Non-surgical management of patients with intrahepatic cholangiocarcinoma in the United States, 2004–2015: an NCDB analysis

Cited by 25 publications

References 17 publications

Potential survival benefit of radiofrequency ablation for small solitary intrahepatic cholangiocarcinoma in nonsurgically managed patients: A population‐based analysis

Potential survival benefit of radiofrequency ablation for small solitary intrahepatic cholangiocarcinoma in nonsurgically managed patients: A population‐based analysis

Ablation in Primary Liver Tumors

Association of liver cirrhosis with the prognosis of patients with intrahepatic cholangiocarcinoma: a SEER-based cohort study

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