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Has Management of Intrahepatic Cholangiocarcinoma Evolved with the Evidence? Trends and Practice Patterns from the National Cancer Database.
- Source :
-
Annals of surgical oncology [Ann Surg Oncol] 2024 Oct; Vol. 31 (10), pp. 6551-6563. Date of Electronic Publication: 2024 Jul 23. - Publication Year :
- 2024
-
Abstract
- Background: Management of intrahepatic cholangiocarcinoma (IHC) has advanced in recent decades, including randomized trial evidence supporting systemic therapy in the palliative and adjuvant setting. Mounting observational evidence suggests resection of IHC with multifocal disease (IHC-MF) or lymph node metastasis (IHC-LNM) should be limited. It is unknown how real-world practice has evolved in light of research advances. This study characterizes trends in management and outcomes of IHC without distant metastasis.<br />Methods: We queried the National Cancer Database (NCDB) for patients treated for IHC without distant metastasis (M0) and identified subgroups with lymph node (cN1) or multifocal hepatic involvement (cT2b). Two-sided Cochran-Armitage tests evaluated trends in initial treating modality and perioperative chemotherapy. Logistic regression evaluated associations with choice of initial treating modality. Overall survival (OS) was evaluated by using Kaplan-Meier methods.<br />Results: Between 2004 and 2020, 11,368 patients were treated for IHC without extrahepatic metastasis. Forty-three percent underwent resection. Initial management shifted from resection towards radiation or systemic therapy in IHC-MF and IHC-LNM. Use of perioperative chemotherapy increased from 39% pre-2010 to 70% in 2018-2020 (p < 0.001), most often delivered postoperatively. Across the entire cohort, median OS improved from 16 (95% confidence interval [CI] 15-18) to 27 months (95% CI 26-29). More modest improvements were observed in IHC-MF and IHC-LNM.<br />Conclusions: Use of perioperative chemotherapy has been widely adopted, predating randomized trial evidence in the adjuvant setting. Initial management of IHC-MF and IHC-LNM has shifted from resection to systemic and/or radiation therapy. While OS has improved overall, outcomes of IHC-MF and IHC-LNM remain poor, warranting further investigation.<br /> (© 2024. Society of Surgical Oncology.)
- Subjects :
- Humans
Male
Female
Survival Rate
Aged
Middle Aged
Hepatectomy
Prognosis
Follow-Up Studies
Disease Management
Combined Modality Therapy
Lymphatic Metastasis
Cholangiocarcinoma therapy
Cholangiocarcinoma pathology
Cholangiocarcinoma surgery
Bile Duct Neoplasms therapy
Bile Duct Neoplasms pathology
Bile Duct Neoplasms surgery
Databases, Factual
Practice Patterns, Physicians' statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1534-4681
- Volume :
- 31
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Annals of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 39042229
- Full Text :
- https://doi.org/10.1245/s10434-024-15724-9