Adjuvant chemotherapy for perihilar cholangiocarcinoma: A population-based comparative cohort study

Sivesh K. Kamarajah; Wasfi Al-Rawashdeh; Alessandro Parente; Phil Atherton; George I. Salti; Fadi S. Dahdaleh; Derek Manas; Mohammed Abu Hilal; Steven A. White

doi:10.1016/j.ejso.2021.12.002

Adjuvant chemotherapy for perihilar cholangiocarcinoma: A population-based comparative cohort study

Sivesh K. Kamarajah, Wasfi Al-Rawashdeh, Alessandro Parente, Phil Atherton, George I. Salti, Fadi S. Dahdaleh, Derek Manas, Mohammed Abu Hilal, Steven A. White^*

^*Corresponding author for this work

Applied Health Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Data supporting routine use of adjuvant chemotherapy (AC) compared to no AC (noAC) for perihilar cholangiocarcinoma (hCCA) is unclear. This study aimed to determine whether AC improves long-term survival following resection for hCCA.

Methods: Patients receiving resection for hCCA followed by AC or no AC from 2010 to 2016 were identified from the National Cancer Database (NCDB). Propensity score matching (PSM) and Cox regression was performed to account for selection bias and analyze impact of AC on overall survival.

Results: Of 924 (56%) noAC and 719 (44%) AC, 320 noAC and 320 AC patients remained after PSM. After matching, AC was associated with improved survival (median: 28.2 vs 19.9 months, p < 0.001), which remained after multivariable adjustment (HR: 0.61, CI_95%: 0.50–0.75, p < 0.001). On multivariable interaction analyses, the benefit of AC over no AC persisted irrespective of nodal status: N0 (HR: 0.62, CI_95%: 0.41–0.92, p = 0.019), N1 (HR: 0.52, CI_95%: 0.36–0.75, p = 0.001), N2 (HR: 0.31, CI_95%: 0.11–0.90, p = 0.032), Nx (HR: 0.22, CI_95%: 0.09–0.55, p = 0.001) and margin status: R0 (HR: 0.74, CI_95%: 0.57–0.97, p = 0.026), R1 (HR: 0.31, CI_95%: 0.21–0.47, p < 0.001). Stratified analysis by nodal, margin and AC status demonstrated consistent results.

Conclusion: AC following resection for hCCA was associated with improved survival in this study, even in margin-negative and node-negative disease. These findings suggest incorporation of AC into multimodality therapy for hCCA in all cases, where appropriate.

Original language	English
Pages (from-to)	1300-1308
Number of pages	9
Journal	European Journal of Surgical Oncology
Volume	48
Issue number	6
Early online date	11 Dec 2021
DOIs	https://doi.org/10.1016/j.ejso.2021.12.002
Publication status	Published - Jun 2022

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology

Keywords

Adjuvant chemotherapy
Outcomes
Perihilar cancer
Resection
Survival

ASJC Scopus subject areas

Surgery
Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{cc4a327a2c644a6ba7d3b0c1f219338f,

title = "Adjuvant chemotherapy for perihilar cholangiocarcinoma: A population-based comparative cohort study",

abstract = "Background: Data supporting routine use of adjuvant chemotherapy (AC) compared to no AC (noAC) for perihilar cholangiocarcinoma (hCCA) is unclear. This study aimed to determine whether AC improves long-term survival following resection for hCCA. Methods: Patients receiving resection for hCCA followed by AC or no AC from 2010 to 2016 were identified from the National Cancer Database (NCDB). Propensity score matching (PSM) and Cox regression was performed to account for selection bias and analyze impact of AC on overall survival. Results: Of 924 (56%) noAC and 719 (44%) AC, 320 noAC and 320 AC patients remained after PSM. After matching, AC was associated with improved survival (median: 28.2 vs 19.9 months, p < 0.001), which remained after multivariable adjustment (HR: 0.61, CI95%: 0.50–0.75, p < 0.001). On multivariable interaction analyses, the benefit of AC over no AC persisted irrespective of nodal status: N0 (HR: 0.62, CI95%: 0.41–0.92, p = 0.019), N1 (HR: 0.52, CI95%: 0.36–0.75, p = 0.001), N2 (HR: 0.31, CI95%: 0.11–0.90, p = 0.032), Nx (HR: 0.22, CI95%: 0.09–0.55, p = 0.001) and margin status: R0 (HR: 0.74, CI95%: 0.57–0.97, p = 0.026), R1 (HR: 0.31, CI95%: 0.21–0.47, p < 0.001). Stratified analysis by nodal, margin and AC status demonstrated consistent results. Conclusion: AC following resection for hCCA was associated with improved survival in this study, even in margin-negative and node-negative disease. These findings suggest incorporation of AC into multimodality therapy for hCCA in all cases, where appropriate.",

keywords = "Adjuvant chemotherapy, Outcomes, Perihilar cancer, Resection, Survival",

author = "Kamarajah, {Sivesh K.} and Wasfi Al-Rawashdeh and Alessandro Parente and Phil Atherton and Salti, {George I.} and Dahdaleh, {Fadi S.} and Derek Manas and Hilal, {Mohammed Abu} and White, {Steven A.}",

note = "Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology",

year = "2022",

month = jun,

doi = "10.1016/j.ejso.2021.12.002",

language = "English",

volume = "48",

pages = "1300--1308",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "Elsevier",

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}

TY - JOUR

T1 - Adjuvant chemotherapy for perihilar cholangiocarcinoma

T2 - A population-based comparative cohort study

AU - Kamarajah, Sivesh K.

AU - Al-Rawashdeh, Wasfi

AU - Parente, Alessandro

AU - Atherton, Phil

AU - Salti, George I.

AU - Dahdaleh, Fadi S.

AU - Manas, Derek

AU - Hilal, Mohammed Abu

AU - White, Steven A.

PY - 2022/6

Y1 - 2022/6

N2 - Background: Data supporting routine use of adjuvant chemotherapy (AC) compared to no AC (noAC) for perihilar cholangiocarcinoma (hCCA) is unclear. This study aimed to determine whether AC improves long-term survival following resection for hCCA. Methods: Patients receiving resection for hCCA followed by AC or no AC from 2010 to 2016 were identified from the National Cancer Database (NCDB). Propensity score matching (PSM) and Cox regression was performed to account for selection bias and analyze impact of AC on overall survival. Results: Of 924 (56%) noAC and 719 (44%) AC, 320 noAC and 320 AC patients remained after PSM. After matching, AC was associated with improved survival (median: 28.2 vs 19.9 months, p < 0.001), which remained after multivariable adjustment (HR: 0.61, CI95%: 0.50–0.75, p < 0.001). On multivariable interaction analyses, the benefit of AC over no AC persisted irrespective of nodal status: N0 (HR: 0.62, CI95%: 0.41–0.92, p = 0.019), N1 (HR: 0.52, CI95%: 0.36–0.75, p = 0.001), N2 (HR: 0.31, CI95%: 0.11–0.90, p = 0.032), Nx (HR: 0.22, CI95%: 0.09–0.55, p = 0.001) and margin status: R0 (HR: 0.74, CI95%: 0.57–0.97, p = 0.026), R1 (HR: 0.31, CI95%: 0.21–0.47, p < 0.001). Stratified analysis by nodal, margin and AC status demonstrated consistent results. Conclusion: AC following resection for hCCA was associated with improved survival in this study, even in margin-negative and node-negative disease. These findings suggest incorporation of AC into multimodality therapy for hCCA in all cases, where appropriate.

AB - Background: Data supporting routine use of adjuvant chemotherapy (AC) compared to no AC (noAC) for perihilar cholangiocarcinoma (hCCA) is unclear. This study aimed to determine whether AC improves long-term survival following resection for hCCA. Methods: Patients receiving resection for hCCA followed by AC or no AC from 2010 to 2016 were identified from the National Cancer Database (NCDB). Propensity score matching (PSM) and Cox regression was performed to account for selection bias and analyze impact of AC on overall survival. Results: Of 924 (56%) noAC and 719 (44%) AC, 320 noAC and 320 AC patients remained after PSM. After matching, AC was associated with improved survival (median: 28.2 vs 19.9 months, p < 0.001), which remained after multivariable adjustment (HR: 0.61, CI95%: 0.50–0.75, p < 0.001). On multivariable interaction analyses, the benefit of AC over no AC persisted irrespective of nodal status: N0 (HR: 0.62, CI95%: 0.41–0.92, p = 0.019), N1 (HR: 0.52, CI95%: 0.36–0.75, p = 0.001), N2 (HR: 0.31, CI95%: 0.11–0.90, p = 0.032), Nx (HR: 0.22, CI95%: 0.09–0.55, p = 0.001) and margin status: R0 (HR: 0.74, CI95%: 0.57–0.97, p = 0.026), R1 (HR: 0.31, CI95%: 0.21–0.47, p < 0.001). Stratified analysis by nodal, margin and AC status demonstrated consistent results. Conclusion: AC following resection for hCCA was associated with improved survival in this study, even in margin-negative and node-negative disease. These findings suggest incorporation of AC into multimodality therapy for hCCA in all cases, where appropriate.

KW - Adjuvant chemotherapy

KW - Outcomes

KW - Perihilar cancer

KW - Resection

KW - Survival

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U2 - 10.1016/j.ejso.2021.12.002

DO - 10.1016/j.ejso.2021.12.002

M3 - Article

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AN - SCOPUS:85121145212

SN - 0748-7983

VL - 48

SP - 1300

EP - 1308

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 6

ER -

Adjuvant chemotherapy for perihilar cholangiocarcinoma: A population-based comparative cohort study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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