HPB and Transplant Unit, Department of Surgical Science, University of Rome Tor Vergata, Rome, Italy.
Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK.
J Gastrointest Surg. 2023 Apr;27(4):741-749. doi: 10.1007/s11605-023-05606-y. Epub 2023 Feb 7.
Data supporting the utilization of neoadjuvant chemotherapy (NAC) in patients receiving resection for cholangiocarcinoma (CCA) remains uncertain. We aimed to determine whether NAC followed by resection improves long-term survival in intrahepatic (iCCA), perihilar (hCCA), and distal (dCCA) cholangiocarcinoma, analyzed separately.
Patients undergoing surgery for iCCA, hCCA, and dCCA, receiving either none, NAC, or adjuvant chemotherapy (AC) from 2010 to 2016 were identified from the National Cancer Database (NCDB). Cox regression was performed to account for selection bias and to assess the impact of surgery alone (SA) versus either NAC or AC on overall survival (OS).
There were 9411 patients undergoing surgery for iCCA (n = 3772, 39.5%), hCCA (n = 1879, 20%), and dCCA (n = 3760, 40%). Of these, 10.6% (n = 399), 6.5% (n = 123), and 7.2% (n = 271) with iCCA, hCCA, and dCCA received NAC, respectively. On adjusted analyses, patients receiving NAC followed by surgery had significantly improved OS, compared to SA for iCCA (HR 0.75, CI 0.64-0.88, p < 0.001), hCCA (HR 0.72, CI 0.54-0.97, p = 0.033), and for dCCA (HR 0.65, CI 0.53-0.78, p < 0.001). However, sensitivity analyses demonstrated no differences in OS between NACs, followed by surgery or AC after surgery in iCCA (HR 1.19, CI 0.99-1.45, p = 0.068), hCCA (HR 0.83 CI 0.59-1.19, p = 0.311), and dCCA (HR 1.13 CI 0.91-1.41, p = 0.264).
This study associated NAC with increased OS for all CCA subtypes, even in patients with margin-negative and node-negative disease; however, no differences were found between NAC and AC. Our results highlight that a careful and interdisciplinary evaluation should be sought to consider NAC in CCA and warrant the need of larger studies to provide robust recommendation.
支持在接受胆管癌（CCA）切除术的患者中使用新辅助化疗（NAC）的数据仍不确定。我们旨在确定 NAC 后切除是否能分别提高肝内（iCCA）、肝门（hCCA）和远端（dCCA）胆管癌的长期生存率。
从国家癌症数据库（NCDB）中确定了 2010 年至 2016 年间接受手术治疗的 iCCA、hCCA 和 dCCA 患者，他们未接受任何治疗、NAC 或辅助化疗（AC）。使用 Cox 回归来解释选择偏倚，并评估单独手术（SA）与 NAC 或 AC 对总生存率（OS）的影响。
共有 9411 名患者接受了 iCCA（n = 3772，39.5%）、hCCA（n = 1879，20%）和 dCCA（n = 3760，40%）的手术治疗。其中，10.6%（n = 399）、6.5%（n = 123）和 7.2%（n = 271）的 iCCA、hCCA 和 dCCA 患者接受了 NAC。在调整后的分析中，与单独接受手术治疗相比，接受 NAC 后手术治疗的患者的 OS 显著改善，分别为 iCCA（HR 0.75，CI 0.64-0.88，p <0.001）、hCCA（HR 0.72，CI 0.54-0.97，p = 0.033）和 dCCA（HR 0.65，CI 0.53-0.78，p <0.001）。然而，敏感性分析表明，在 iCCA（HR 1.19，CI 0.99-1.45，p = 0.068）、hCCA（HR 0.83，CI 0.59-1.19，p = 0.311）和 dCCA（HR 1.13，CI 0.91-1.41，p = 0.264）中，NAC 后手术或手术后接受 AC 治疗的患者的 OS 之间无差异。
这项研究表明，NAC 与所有 CCA 亚型的 OS 增加相关，即使在边缘阴性和淋巴结阴性的患者中也是如此；然而，NAC 和 AC 之间没有发现差异。我们的研究结果表明，应该仔细进行跨学科评估以考虑在 CCA 中使用 NAC，并需要进行更大规模的研究以提供有力的建议。
