Research Fellow Northwestern University Chicago, Illinois, United States
Disclosure: Disclosure information not submitted.
Participants should be aware of the following financial/non-financial relationships:
Casey Silver, MD: Disclosure information not submitted.
Introduction: Surgery followed by adjuvant therapy is considered the standard of care treatment for extrahepatic cholangiocarcinoma (eCCA), though survival is poor. Evidence regarding the role of neoadjuvant therapy (NAT), including chemotherapy or chemoradiation (CRT), is limited. Our objectives were to (1) characterize treatment trends over time, (2) identify factors associated with the use of NAT, and (3) evaluate the association between NAT and short- and long-term outcomes.
Methods: Patients who underwent surgery for eCCA were identified in the National Cancer Database (2004-2017). Factors associated with NAT were assessed by cluster-adjusted multivariable logistic regression. The associations between NAT and postoperative outcomes and overall survival (OS) were assessed with propensity-score adjusted multivariable logistic regression and cox proportional hazards models. Stratified analysis assessed differences in outcomes between surgery first, neoadjuvant chemotherapy, and neoadjuvant CRT groups.
Results: Among 8849 patients with eCCA, 456 (5.1%) received NAT (chemotherapy: 237 (52%), CRT: 219 (48%)). Overall, NAT increased during the study period 2.84% to 8.12% (p< 0.001). Factors associated with the use of NAT included age < 50 years (vs >75), stage 3 (vs 0/1), distance traveled >100 miles (vs < 50) and diagnosis in 2016-2017 (vs 2004-2005), (all p < 0.05). Compared with surgery first, patients who received NAT had higher odds of R0 resection (OR 1.56), lower 30-day (OR 0.46) and 90-day mortality (OR 0.59), and improved OS (HR 0.79), (all p< 0.05). On stratified analysis, neoadjuvant chemotherapy was not associated with differences in any of these outcomes compared with surgery first. However, neoadjuvant CRT was associated with improvement in R0 resection (OR 3.83), 90-day mortality (OR 0.34), and OS (HR 0.71) compared to surgery first (all p< 0.05).
Conclusions: The use of NAT for eCCA increased over the study period and was associated with several factors. Compared to surgery first, NAT, particularly neoadjuvant CRT, was associated with improved postoperative outcomes and OS. These observational data suggest expanding the use of neoadjuvant CRT for eCCA.
Learning Objectives:
Upon completion, participants will be able to discuss trends in management of extrahepatic cholangiocarcinoma.
Upon completion, participants will be able to describe factors associated with the used of neoadjuvant therapy in extrahepatic cholangiocarcinoma.
Upon completion, participants will be able to describe the association between neoadjuvant therapy and postoperative outcomes and overall survival in extrahepatic cholangiocarcinoma.
