Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma: A multi-institution analysis from the US extrahepatic biliary malignancy consortium

• Type of Material: Article
• Authors: Bradley A. Krasnick, Washington University; Linda X. Jin, Washington University; Jesse T. Davidson, Washington University; Dominic E. Sanford, Washington University; Cecilia G. Ethun, Emory University; Timothy M. Pawlik, Ohio State University; George A. Poultsides, Stanford University; Thuy Tran, Stanford University; Kamran Idrees, Vanderbilt University; William G. Hawkins, Washington University; William C. Chapman, Washington University; Maria B. Majella Doyle, Washington University; Sharon M. Weber, University of Wisconsin; Steven M. Strasberg, Washington University; Ahmed Salem, University of Wisconsin; Robert C.G. Martin, University of Louisville; Chelsea A. Isom, Vanderbilt University; Charles Scoggins, University of Louisville; Carl R. Schmidt, Ohio State University; Perry Shen, Wake Forest University; Eliza Beal, Ohio State University; Ioannis Hatzaras, New York University; Rivfka Shenoy, New York University; Shishir Kumar Maithel, Emory University; Ryan C. Fields, Washington University
• Language: English
• Date: 2018-03-01
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.24836
• Title of Journal or Parent Work: Journal of Surgical Oncology
• Volume: 117
• Issue: 3
• Start Page: 363
• End Page: 371
• Grant/Funding Information: No funding sources to report
• Keywords: RECURRENCE; TRIAL; PATIENT; GEMCITABINE; hilar cholangiocarcinoma; CHEMOTHERAPY; Oncology; survival; Life Sciences & Biomedicine; Science & Technology; chemotherapy; biliary cancer; TRACT CANCER; GALLBLADDER CARCINOMA; Surgery; adjuvant therapy
• Research Categories: Health Sciences, Public Health; Health Sciences, Oncology

Abstract

Background: Curative-intent treatment for localized hilar cholangiocarcinoma (HC) requires surgical resection. However, the effect of adjuvant therapy (AT) on survival is unclear. We analyzed the impact of AT on overall (OS) and recurrence free survival (RFS) in patients undergoing curative resection. Methods: We reviewed patients with resected HC between 2000 and 2015 from the ten institutions participating in the U.S. Extrahepatic Biliary Malignancy Consortium. We analyzed the impact of AT on RFS and OS. The probability of RFS and OS were calculated in the method of Kaplan and Meier and analyzed using multivariate Cox regression analysis. Results: A total of 249 patients underwent curative resection for HC. Patients who received AT and those who did not had similar demographic and preoperative features. In a multivariate Cox regression analysis, AT conferred a significant protective effect on OS (HR 0.58, P = 0.013), and this was maintained in a propensity matched analysis (HR 0.66, P = 0.033). The protective effect of AT remained significant when node negative patients were excluded (HR 0.28, P = 0.001), while it disappeared (HR 0.76, P = 0.260) when node positive patients were excluded. Conclusions: AT should be strongly considered after curative-intent resection for HC, particularly in patients with node positive disease.