Prognostic Factors for Survival in Patients with Advanced Intrahepatic Cholangiocarcinoma Treated with Gemcitabine plus Cisplatin as First-Line Treatment

Abstract

Objectives: Intrahepatic cholangiocarcinoma (ICC) is a rare type of liver cancer. No clinically useful prognostic factors have been reported for patients with advanced ICC. In the present study, we aimed to evaluate the clinical prognostic factors of patients with advanced ICC receiving gemcitabine plus cisplatin combination therapy (GC) as standard first-line chemotherapy. Methods: A retrospective analysis was performed of the data of patients with ICC treated at our institution from March 2011 to January 2016. We used the Cox regression model and estimated the hazard ratios of potential prognostic factors for survival. Results: Of 216 patients with biliary tract cancer receiving GC as first-line chemotherapy, we extracted data for 77 patients who were diagnosed with ICC and received GC as first-line chemotherapy. The median overall survival was 13.8 months (95% CI, 8.9-18.6). In multivariate analysis, pretreatment serum lactate dehydrogenase (hazard ratio [HR]: 2.53, p = 0.005), C-reactive protein (HR: 3.06, p = 0.001), and carcinoembryonic antigen (HR: 2.39, p = 0.03) levels were significantly associated with overall survival. Conclusions: Readily available clinical laboratory values reliably predicted the prognosis of ICC patients receiving GC therapy. If validated in other studies, these results may provide a useful tool for individual patient-risk evaluation and the design and interpretation of future trials.

Predictive factors of the treatment outcome in patients with advanced biliary tract cancer receiving gemcitabine plus cisplatin as first-line chemotherapy

“…Elevated serum LDH has been reported to be associated with chemo-resistance to several anticancer-drugs such as paclitaxel, cetuximab and gemcitabine [27–29]. Therefore, consistent with previous reports to the previous studies [12, 18, 19, 30], our study also suggested that elevated serum LDH might be associated with a worse OS in patients with advanced BTC receiving GC therapy.…”

“…However, from the few studies conducted until date, no predictors of the OS have been identified yet. In addition, few prognostic indexes have been constructed and few validation studies of the prognostic index have been conducted [8–12]. The purpose of this study, therefore, was to identify and then conduct the prognostic index of OS, and validate it, in patients with advanced BTC receiving GC as first-line chemotherapy.…”

Prognostic and predictive factors for Taiwanese patients with advanced biliary tract cancer undergoing frontline chemotherapy with gemcitabine and cisplatin: a real-world experience

“…In addition, the location of the primary tumour and the sites of advanced BTC were the suggested prognostic factors, although they did not achieve statistical significance [20]. Ishimoto et al reported 77 patients with pure iCCA and observed that lactate dehydrogenase (LDH), C-reactive protein (CRP), and CEA levels were significantly associated with OS in the multivariate analysis [21]. Suzuki et al analysed 307 patients and identified poor ECOG performance status, elevated serum LDH, and elevated NLR as independent unfavourable prognostic factors [22].…”

Prognostic Factors for Overall Survival in Advanced Intrahepatic Cholangiocarcinoma Treated with Yttrium-90 Radioembolization

“…While surgical techniques have expanded in recent years, allowing for curative approaches even for advanced Klatskin tumors applying procedures such as associating liver partition and portal vein ligation (ALPPS) and portal vein embolization (PVE) with subsequent extended liver resection, intrahepatic cholangiocarcinoma can rarely be resected in a curative manner [16,17]. Moreover, biliary tract cancer shows poor response rates to systemic chemotherapy, with overall survival previously reported for gemcitabine monotherapy of 8.1 months and gemcitabine plus cisplatin of 11.7 months [5]; 13.8 months for intrahepatic cholangiocarcinoma [18] and 16.2 months for hepatocholangiocarcinoma [19]. A recent post-hoc analysis of three large clinical trials on advanced ICC showed survival rates of 16.7 months following 3 to 6 months of chemotherapy, which likely reflects improved patient selection and improvements in chemotherapy regimens [6].…”