Temporal trends in liver-directed therapy of patients with intrahepatic cholangiocarcinoma in the United States: A population-based analysis

Amini, Neda; Ejaz, Aslam; Spolverato, Gaya; Kim, Yuhree; Herman, Joseph M.; Pawlik, Timothy M.

doi:10.1002/jso.23605

Cited by 102 publications

(86 citation statements)

References 50 publications

(73 reference statements)

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“…Amini et al reported that in reviewing 1,232 patients selected from the SEER database, only 64 (5.2%) patients underwent ablation therapy alone. Interestingly, they noted that the median survival of patients treated with ablation therapy was 20 months, which was worse than that of patients treated with resection but better than that of patients treated with radiation therapy alone (23). Although these outcomes are likely to be influenced by the differences in the baseline characteristics of the patients in each group, for a selected group of patients, RFA might confer a modest survival advantage, compared with other non-surgical treatment options including radiation therapy or chemotherapy.…”

Section: Effectiveness Of Rfamentioning

confidence: 99%

“…A multivariate analysis in the study using the SEER database (23) revealed that ablation therapy may have a preferable prognostic impact, compared with the best supportive care (BSC), with a hazard ratio (HR) of 0.57 (95% CI, 0.40-0.83), while surgery alone (HR, 0.46; 95% CI, 0.39-0.54) or surgery + radiotherapy (HR, 0.46; 95% CI, 0.35-0.60) were strongly correlated with a better survival outcome.…”

Section: Prognostic Impact and Role Of Rfa In Multidisciplinary Treatmentioning

confidence: 99%

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Ablative therapies for intrahepatic cholangiocarcinoma

Shindoh¹

2017

Hepatobiliary Surg. Nutr.

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Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy.Although surgical resection has been a cornerstone in the management of ICC, the efficacies of several nonsurgical management strategies have been actively investigated and somewhat preferable outcomes have been reported for ablation therapies in selected cases. Nevertheless, because of the rarity of these tumors and the small number of studies, the clinical significance and actual role of ablation therapies in a multidisciplinary approach for ICC remain unclear. In this article, the reported outcomes of ablation therapies for ICC will be summarized and their potential indications will be discussed.

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Section: Effectiveness Of Rfamentioning

confidence: 99%

Section: Prognostic Impact and Role Of Rfa In Multidisciplinary Treatmentioning

confidence: 99%

Ablative therapies for intrahepatic cholangiocarcinoma

Shindoh¹

2017

Hepatobiliary Surg. Nutr.

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“…5 As such, only 20-40 % of patients with ICC are considered potentially operable at the time of presentation and are offered surgical resection. 6,7 When feasible, hepatic resection remains the best potential curative treatment for ICC. However, even after curative-intent surgery, the 5-year survival of patients undergoing liver resection ranges from only 30-35 %, with a median overall survival of approximately 28 months.…”

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confidence: 99%

Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative intent surgical resection.

Spolverato

Kim

Alexandrescu

et al. 2015

JCO

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349 Background: Many patients develop recurrence following resection of intrahepatic cholangiocarcinoma(ICC). Management and outcomes of patients with recurrent ICC following previous curative-intent surgery are not well documented. We sought to characterize the treatment of patients with recurrent ICC and define therapy-specific outcomes. Methods: Between 1990-2013, 542 patients who underwent surgery for ICC were identified from an international database. Data on clinicopathological characteristics, operative details, recurrence and recurrence-related management were recorded and analyzed. Results: At initial surgery, treatment was resection only(96.1%) or resection+RFA(3.9%). Overall 5-year survival was 25.9%; 376(69.4%) patients recurred with a median disease-free survival of 11.0 months. Vascular invasion(hazard ratio [HR]=1.43), nodal metastasis(HR=1.40) and poor differentiation(HR=1.30) were predictive of recurrence(all P<0.05). First recurrence site was intrahepatic only (62.0%), extrahepatic only (14.1%), or intra- and extrahepatic(23.9%). Overall 259(68.9%) patients received treatment for recurrent ICC, while 117(31.1%) received best supportive care(BSC). Among patients who received treatment for recurrent disease, therapy consisted of systemic chemotherapy only(49.4%), repeat liver-directed therapy (25.9%), or systemic chemotherapy+liver-directed therapy(24.7%). Repeat liver-directed therapy consisted of repeat hepatic resection±ablation(30.5%), ablation alone (21.4%), and intra-arterial therapy(IAT)(48.1%). Among patients who recurred, median survival from the time of the recurrence was 11.0 months(BSC-7.7 months, systemic chemotherapy only-10.0 months, liver-directed therapy-18.0 months). The median survival of patients undergoing resection of recurrent ICC was 26.7 months versus 7.6 months for patients who had IAT(P<0.001). Conclusions: Recurrence following resection of ICC is common, occurring in up to two-thirds of patients. When recurrence occurs, prognosis is poor. In well-selected patients with liver only recurrence, resection+chemotherapy may offer a modest survival benefit.

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“…Few studies [7,9] have compared the outcomes of patients undergoing surgical resection for ICC with those undergoing non-surgical treatments. Moreover, the survival benefits of surgical resection have not been compared among patients with IM, VI, or LM.…”

Section: Introductionmentioning

confidence: 99%

Is Surgical Resection Justified for Advanced Intrahepatic Cholangiocarcinoma?

et al. 2016

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Backgrounds: Prognosis for patients with advanced intrahepatic cholangiocarcinoma (ICC) with intrahepatic metastasis (IM), vascular invasion (VI), or regional lymph node metastasis (LM) remains poor. The aim of this study was to clarify the indications for surgical resection for advanced ICC. Methods: We retrospectively divided 213 ICC patients treated at Kyoto University Hospital between 1993 and 2013 into a resection (n=164) group and a non-resection (n=49) group. Overall survival was assessed after stratification for the presence of IM, VI, or LM. Results: Overall median survival times (MSTs) for the resection and non-resection groups were 26.0 and 7.1 months, respectively (p<0.001). After stratification, MSTs in the resection and non-resection groups, respectively, were 18.7 vs. 7.0 months for patients with IM (p<0.001), 23.4 vs. 5.7 months for those with VI (p<0.001), and 12.8 vs. 5.5 months for those with LM (p<0.001). Conclusion: When macroscopic curative resection is possible, surgical resection can be justified for some advanced ICC patients with IM, VI, or LM.

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Temporal trends in liver-directed therapy of patients with intrahepatic cholangiocarcinoma in the United States: A population-based analysis

Cited by 102 publications

References 50 publications

Ablative therapies for intrahepatic cholangiocarcinoma

Ablative therapies for intrahepatic cholangiocarcinoma

Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative intent surgical resection.

Is Surgical Resection Justified for Advanced Intrahepatic Cholangiocarcinoma?

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