Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Cancer Med. 2023 Jun;12(11):12272-12284. doi: 10.1002/cam4.5925. Epub 2023 Apr 16.
The role of locoregional therapy compared to systemic chemotherapy (SYS) for unresectable intrahepatic cholangiocarcinoma (IHC) remains controversial. The importance of hepatic disease control, either as initial or salvage therapy, is also unclear. We compared overall survival (OS) in patients treated with resection, hepatic arterial infusion pump (HAIP) chemotherapy, or SYS as it relates to hepatic recurrence or progression. We also evaluated recurrence after resection to determine the efficacy of locoregional salvage therapy.
In this single-institution retrospective analysis, patients with biopsy-proven IHC treated with either curative-intent resection, HAIP (with or without SYS), or SYS alone were analyzed. Propensity score matching (PSM) was used to compare patients with liver-limited, advanced disease treated with HAIP versus SYS. The impact of locoregional salvage therapies in patients with liver-limited recurrence was analyzed in the resection cohort.
From 2000 to 2017, 714 patients with IHC were treated, 219 (30.7%) with resectable disease, 316 (44.3%) with locally advanced disease, and 179 (25.1%) with metastatic disease. Resected patients were less likely to recur or progress in the liver (hazard ratio [HR] 0.41, 95% CI 0.34-0.45) versus those that received HAIP or SYS (HR 0.58, 95% CI 0.50-0.65 vs. HR 0.63, 95% CI 0.57-0.69, respectively). In resected patients, 161 (64.4%) recurred, with 65 liver-only recurrences. Thirty of these patients received subsequent locoregional therapy. On multivariable analysis, locoregional therapy was associated with improved OS after isolated liver recurrence (HR 0.46, 95% CI 0.29-0.75; p = 0.002). In patients with locally advanced unresectable or multifocal liver disease (with or without distant organ metastases), PSM demonstrated improved hepatic progression-free survival in patients treated with HAIP versus SYS (HR 0.65; 95% CI 0.46-0.91; p = 0.01), which correlated with improved OS (HR 0.59, 95% CI 0.43-0.80; p < 0.001).
In patients with liver-limited IHC, hepatic disease control is associated with improved OS, emphasizing the potential importance of liver-directed therapy.
局部区域治疗与不可切除的肝内胆管癌（IHC）的全身化疗（SYS）相比的作用仍存在争议。控制肝脏疾病的重要性，无论是初始治疗还是挽救性治疗，也尚不清楚。我们比较了接受切除术、肝动脉输注泵（HAIP）化疗或 SYS 治疗的患者的总生存期（OS），因为这与肝复发或进展有关。我们还评估了切除术后的复发情况，以确定局部区域挽救性治疗的疗效。
在这项单机构回顾性分析中，对接受根治性切除术、HAIP（有或没有 SYS）或 SYS 单独治疗的经活检证实的 IHC 患者进行了分析。使用倾向评分匹配（PSM）比较了接受 HAIP 与 SYS 治疗的肝局限性晚期疾病患者。在切除术队列中分析了肝局限性复发患者接受局部区域挽救性治疗的影响。
2000 年至 2017 年，714 例 IHC 患者接受了治疗，219 例（30.7%）为可切除疾病，316 例（44.3%）为局部晚期疾病，179 例（25.1%）为转移性疾病。与接受 HAIP 或 SYS 治疗的患者相比，接受切除术的患者肝脏复发或进展的可能性更低（风险比[HR]0.41，95%CI 0.34-0.45）（HR 0.58，95%CI 0.50-0.65 与 HR 0.63，95%CI 0.57-0.69，分别）。在接受切除术的患者中，161 例（64.4%）复发，其中 65 例为单纯肝脏复发。这些患者中有 30 例接受了后续的局部区域治疗。多变量分析显示，孤立性肝复发后接受局部区域治疗与 OS 改善相关（HR 0.46，95%CI 0.29-0.75；p=0.002）。对于局部晚期不可切除或多灶性肝疾病（伴或不伴远处器官转移）患者，PSM 显示接受 HAIP 治疗的患者与接受 SYS 治疗的患者相比，肝无进展生存期（HR 0.65；95%CI 0.46-0.91；p=0.01）有所改善，这与 OS 改善相关（HR 0.59，95%CI 0.43-0.80；p<0.001）。
在肝局限性 IHC 患者中，控制肝脏疾病与 OS 改善相关，这强调了肝定向治疗的潜在重要性。
Zotero 插件
