TY - JOUR
T1 - Local therapy reduces the risk of liver failure and improves survival in patients with intrahepatic cholangiocarcinoma
T2 - A comprehensive analysis of 362 consecutive patients
AU - Yamashita, Suguru
AU - Koay, Eugene Jon
AU - Passot, Guillaume
AU - Shroff, Rachna
AU - Raghav, Kanwal P.
AU - Conrad, Claudius
AU - Chun, Yun Shin
AU - Aloia, Thomas A.
AU - Tao, Randa
AU - Kaseb, Ahmed
AU - Javle, Milind
AU - Crane, Christopher H.
AU - Vauthey, Jean Nicolas
N1 - Funding Information:
This study was supported in part by the National Institutes of Health through MD Anderson Cancer Center Support Grant CA016672.
Publisher Copyright:
© 2016 American Cancer Society
PY - 2017/4/15
Y1 - 2017/4/15
N2 - BACKGROUND: Treatment methods for intrahepatic cholangiocarcinoma (ICC) have improved, but their impact on outcome remains unclear. We evaluated the outcomes of patients definitively treated with resection, radiation, and chemotherapy for ICC, stratified by era. METHODS: Clinico-pathologic characteristics, cause of death, disease-specific survival (DSS), and intrahepatic progression-free survival (IPFS) were compared among patients who underwent resection, radiation, or chemotherapy as definitive treatment strategies for ICC (without distant organ metastasis) between 1997 and 2015. Variables were also analyzed by era (1997-2006 [early] or 2007-2015 [late]) within each group. RESULTS: Among 362 patients in our cohort, 122 underwent resection (early, 38; late, 84), 85 underwent radiation (early, 17; late, 68), and 148 underwent systemic chemotherapy alone (early, 51; late, 97) as definitive treatment strategies, and 7 patients received best supportive care. In the resection group, the 3-year DSS rate was 58% for the early era and 67% for the late era (P =.036), and the 1-year IPFS was 50% for the early era and 75% for the late era (P =.048). In the radiation group, the 3-year DSS was 12% for the early era and 37% for the late era (P =.048), and the 1-year IPFS was 48% for the early era and 64% for the late era (P =.030). In the chemotherapy group, DSS and IPFS did not differ by era. Patients treated with chemotherapy developed liver failure at the time of death significantly more frequently than patients treated with resection (P <.001) or radiation (P <.001). Multivariable analysis identified local therapy (resection or radiation) as a sole predictor of death without liver failure. CONCLUSION: Survival outcomes have improved for local therapy-based definitive treatment strategies for ICC, which may be attributable to maintaining control of intrahepatic disease, thereby reducing the occurrence of death due to liver failure. Cancer 2017;123:1354–1362.
AB - BACKGROUND: Treatment methods for intrahepatic cholangiocarcinoma (ICC) have improved, but their impact on outcome remains unclear. We evaluated the outcomes of patients definitively treated with resection, radiation, and chemotherapy for ICC, stratified by era. METHODS: Clinico-pathologic characteristics, cause of death, disease-specific survival (DSS), and intrahepatic progression-free survival (IPFS) were compared among patients who underwent resection, radiation, or chemotherapy as definitive treatment strategies for ICC (without distant organ metastasis) between 1997 and 2015. Variables were also analyzed by era (1997-2006 [early] or 2007-2015 [late]) within each group. RESULTS: Among 362 patients in our cohort, 122 underwent resection (early, 38; late, 84), 85 underwent radiation (early, 17; late, 68), and 148 underwent systemic chemotherapy alone (early, 51; late, 97) as definitive treatment strategies, and 7 patients received best supportive care. In the resection group, the 3-year DSS rate was 58% for the early era and 67% for the late era (P =.036), and the 1-year IPFS was 50% for the early era and 75% for the late era (P =.048). In the radiation group, the 3-year DSS was 12% for the early era and 37% for the late era (P =.048), and the 1-year IPFS was 48% for the early era and 64% for the late era (P =.030). In the chemotherapy group, DSS and IPFS did not differ by era. Patients treated with chemotherapy developed liver failure at the time of death significantly more frequently than patients treated with resection (P <.001) or radiation (P <.001). Multivariable analysis identified local therapy (resection or radiation) as a sole predictor of death without liver failure. CONCLUSION: Survival outcomes have improved for local therapy-based definitive treatment strategies for ICC, which may be attributable to maintaining control of intrahepatic disease, thereby reducing the occurrence of death due to liver failure. Cancer 2017;123:1354–1362.
KW - chemotherapy
KW - intrahepatic cholangiocarcinoma
KW - intrahepatic progression-free survival
KW - local therapy
KW - radiation
KW - resection
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U2 - 10.1002/cncr.30488
DO - 10.1002/cncr.30488
M3 - Article
C2 - 27984655
AN - SCOPUS:85017197997
SN - 0008-543X
VL - 123
SP - 1354
EP - 1362
JO - Cancer
JF - Cancer
IS - 8
ER -