Kawashima Jun, Endo Yutaka, Woldesenbet Selamawit, Khalil Mujtaba, Akabane Miho, Cauchy François, Shen Feng, Maithel Shishir, Popescu Irinel, Kitago Minoru, Weiss Matthew J, Martel Guillaume, Pulitano Carlo, Aldrighetti Luca, Poultsides George, Ruzzente Andrea, Bauer Todd W, Gleisner Ana, Marques Hugo, Groot Koerkamp Bas, Endo Itaru, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
Ann Surg Oncol. 2025 Jun;32(6):4341-4351. doi: 10.1245/s10434-025-17013-5. Epub 2025 Feb 17.
While postoperative adjuvant chemotherapy (AC) is generally recommended for intrahepatic cholangiocarcinoma (ICC), its benefit remains debated. This study aimed to identify patients that may benefit from AC following liver resection of ICC.
Patients who underwent liver resection for ICC between 2000 and 2023 were identified from an international multi-institutional database. Individual multivariable Cox models were used to evaluate the interaction between each prognostic factor and the effect of AC on survival.
Among 1412 patients, 431 (30.5%) received AC. Both higher tumor burden score (TBS; hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.91-1.00; p = 0.033) and metastatic lymph node status (HR 0.58, 95% CI 0.38-0.89; p = 0.014) demonstrated interactions with the survival benefit from receipt of AC. Interaction plots highlighted how AC was associated with improved survival beyond a TBS of approximately 6. Notably, among 555 (39.3%) patients with TBS <6 and N0 or Nx status, 5-year overall survival (OS) was no different between patients who received AC versus individuals who did not (55.1% [95% CI 48.9-62.1] vs. 58.7% [95% CI 49.8-69.2]; p = 0.900). In contrast, among 857 (60.7%) patients with TBS ≥6 or N1 status, AC was associated with improved 5-year OS (30.7% [95% CI 26.2-36.0] vs. 33.0% [95% CI 26.9-40.5]; p = 0.018).
TBS and lymph node status may be useful in a multidisciplinary setting to inform decisions about AC planning for ICC patients following curative-intent resection.
虽然术后辅助化疗（AC）通常被推荐用于肝内胆管癌（ICC），但其益处仍存在争议。本研究旨在确定肝切除术后可能从AC中获益的ICC患者。
从一个国际多机构数据库中识别出2000年至2023年间接受ICC肝切除术的患者。使用个体多变量Cox模型评估每个预后因素与AC对生存影响之间的相互作用。
在1412例患者中，431例（30.5%）接受了AC。较高的肿瘤负荷评分（TBS；风险比[HR]0.95，95%置信区间[CI]0.91-1.00；p = 0.033）和转移性淋巴结状态（HR 0.58，95% CI 0.38-0.89；p = 0.014）均显示与接受AC的生存获益存在相互作用。相互作用图突出显示了AC如何与TBS约为6以上时的生存改善相关。值得注意的是，在555例（39.3%）TBS<6且N0或Nx状态的患者中，接受AC的患者与未接受AC的患者5年总生存率（OS）无差异（55.1%[95% CI 48.9-62.1]对58.7%[95% CI 49.8-69.2]；p = 0.900）。相比之下，在857例（60.7%）TBS≥6或N1状态的患者中，AC与5年OS改善相关（30.7%[95% CI 26.2-36.0]对33.0%[95% CI 26.9-40.5]；p = 0.018）。
在多学科背景下，TBS和淋巴结状态可能有助于为根治性切除术后的ICC患者制定AC计划提供决策依据。
