Time to Rethink Upfront Surgery for Resectable Intrahepatic Cholangiocarcinoma? Implications from the Neoadjuvant Experience

Mason, Meredith C.; Massarweh, Nader N.; Tzeng, Ching Wei D.; Chiang, Yi Ju; Chun, Yun Shin; Aloia, Thomas A.; Javle, Milind; Vauthey, Jean Nicolas; Cao, Hop S. Tran

doi:10.1245/s10434-020-09536-w

Cited by 26 publications

(27 citation statements)

References 28 publications

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“…The efficacy of neoadjuvant therapy in patients with ICCA is controversial. Recent studies have shown that neoadjuvant therapy can reduce the risk of death and improve overall survival 28 , 29 , while some researchers believe that neoadjuvant is only associated with improved OS over upfront surgery in patients with resectable ICCA and high risk of treatment failure 30 . At present, most studies found that adjuvant therapy did not influence the prognosis of all ICCA patients following surgical resection; it was associated with a potential survival benefit in patients with high-risk features (such as positive margins, positive lymph nodes, or advanced T stage) 31 – 35 .…”

Section: Discussionmentioning

confidence: 99%

Primary tumor resection improves survival in patients with multifocal intrahepatic cholangiocarcinoma based on a population study

Yin

Zhao

Zhu

et al. 2021

Sci Rep

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The purpose of our study was to evaluate the effect of surgery on the survival and prognosis of patients with multifocal intrahepatic cholangiocarcinoma (ICCA). Patients with multifocal ICCA were selected from the SEER (Surveillance, Epidemiology, and End Results) database between 2010 and 2016. Kaplan–Meier analyses and log-rank tests were used to evaluate the difference in survival between the surgery group and the non-surgery group. We applied the Cox proportional hazards regression model to identify prognostic factors of overall survival (OS) and cancer-specific survival (CSS). In total, 580 patients were enrolled in our study, including 151 patients who underwent surgery and 429 patients who did not. The median survival time of surgical patients was longer than non-surgical patients (OS: 25 months vs. 8 months, p < 0.001; CSS: 40 months vs. 25 months, p < 0.001). Similarly, the 5-year survival rate in the surgery group was significantly higher than those in the non-surgery group (5-year OS rate: 12.91% vs. 0%; p < 0.001; 5-year CSS rate:26.91% vs. 0%; p < 0.001). Multivariate Cox analysis showed that the OS (HR:0.299, 95% CI: 0.229–0.390, p < 0.001) and CSS (HR:0.305, 95% CI:0.222–0.419, p < 0.001) of patients undergoing surgical resection were significantly improved. Meanwhile, after propensity score matching (PSM) of the original data, we come to the same conclusion.

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Section: Discussionmentioning

confidence: 99%

Primary tumor resection improves survival in patients with multifocal intrahepatic cholangiocarcinoma based on a population study

Yin

Zhao

Zhu

et al. 2021

Sci Rep

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“…Indeed, neoadjuvant chemotherapy was associated with longer overall survival in patients than in those who underwent upfront surgical resection followed by adjuvant chemotherapy (40.3 months versus 32.8 months; p = 0.01). Another cohort study of more than 4000 patients, after propensity matching, demonstrated that neoadjuvant therapy was associated with a 23% reduced risk of death compared with upfront surgery [ 97 ]. More data are needed, particularly generated by prospective clinical trials (such as NCT03579771), to define possible indications for neoadjuvant regimens in patients with resectable ICC.…”

Section: Systemic Treatmentmentioning

confidence: 99%

Treatment of Intrahepatic Cholangiocarcinoma—A Multidisciplinary Approach

Krenzien

Nevermann

Krombholz

et al. 2022

Cancers

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Intrahepatic cholangiocarcinoma (iCC) is distinguished as an entity from perihilar and distal cholangiocarcinoma and gallbladder carcinoma. Recently, molecular profiling and histopathological features have allowed further classification. Due to the frequent delay in diagnosis, the prognosis for iCC remains poor despite major technical advances and multimodal therapeutic approaches. Liver resection represents the therapeutic backbone and only curative treatment option, with the functional residual capacity of the liver and oncologic radicality being deciding factors for postoperative and long-term oncological outcome. Furthermore, in selected cases and depending on national guidelines, liver transplantation may be a therapeutic option. Given the often advanced tumor stage at diagnosis or the potential for postoperative recurrence, locoregional therapies have become increasingly important. These strategies range from radiofrequency ablation to transarterial chemoembolization to selective internal radiation therapy and can be used in combination with liver resection. In addition, adjuvant and neoadjuvant chemotherapies as well as targeted therapies and immunotherapies based on molecular profiles can be applied. This review discusses multimodal treatment strategies for iCC and their differential use.

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“…Mason et al studied the role of NAT in resectable iCCA in a retrospective cohort study of 4456 patients. ( 4 ) They found a 23% decreased risk of death associated with the use of NAT in comparison with upfront surgery for resectable iCCA. ( 4 ) Those who received NAT had a 5‐year OS rate of 37.2% compared with 29.9% in those who had upfront surgery.…”

mentioning

confidence: 99%

“…( 4 ) They found a 23% decreased risk of death associated with the use of NAT in comparison with upfront surgery for resectable iCCA. ( 4 ) Those who received NAT had a 5‐year OS rate of 37.2% compared with 29.9% in those who had upfront surgery. ( 4 ) When used in conjunction with LT, NAT has the potential to provide even greater OS rates.…”

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confidence: 99%

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The New Era of Liver Transplantation for Cholangiocarcinoma: No Longer Just a 1‐Man Show

Desai

Pillai

2021

Liver Transpl

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Liver transplantation (LT) has emerged as a novel therapy for patients with cholangiocarcinoma (CCA) who were previously deemed unresectable. Although initial data showed poor survival after LT alone, neoadjuvant chemoradiotherapy with LT showed great promise. This became the basis for the Mayo protocol that has rightfully been the standard of care for selecting and managing patients with hilar CCA (hCCA) for LT for the past 2 decades. (1,2) However, its restrictive patient selection and standardized protocol necessitates further research into whether neoadjuvant chemoradiotherapy, its individualized components, and LT could be a validated approach in a broader population of patients with CCA.In this issue, Ito et al. conduct a single-center retrospective analysis studying the impact of era, tumor size, and neoadjuvant therapy (NAT) on patients with CCA who received an LT from 1985 to 2019. (3) The authors conclude that in comparison with the old era , the recent era (2008-2019) has a superior trend in terms of overall survival (OS) rate, largely

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Time to Rethink Upfront Surgery for Resectable Intrahepatic Cholangiocarcinoma? Implications from the Neoadjuvant Experience

Cited by 26 publications

References 28 publications

Primary tumor resection improves survival in patients with multifocal intrahepatic cholangiocarcinoma based on a population study

Primary tumor resection improves survival in patients with multifocal intrahepatic cholangiocarcinoma based on a population study

Treatment of Intrahepatic Cholangiocarcinoma—A Multidisciplinary Approach

The New Era of Liver Transplantation for Cholangiocarcinoma: No Longer Just a 1‐Man Show

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