Neoadjuvant therapy reduces node positivity but does not confer survival benefit versus up‐front resection for resectable intrahepatic cholangiocarcinoma: A propensity‐matched analysis

Background Neoadjuvant systemic therapy (NAST) is a treatment option for intrahepatic cholangiocarcinoma (iCCA), though its impact on short‐term oncologic outcomes and long‐term survival remains relatively unknown. Methods The National Cancer Database (NCDB) between 2004 and 2019 was queried for pat...

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Published in:Journal of surgical oncology 2024-09, Vol.130 (3), p.453-461
Main Authors: Wehrle, Chase J., Chang, Jenny, Woo, Kimberly, Gross, Abby, Naples, Robert, Dahdaleh, Fadi, Stackhouse, Kathryn, Kim, Jaekeun, Augustin, Toms, Simon, Robert, Joyce, Daniel, Kwon, David C. H., Miller, Charles, Walsh, R. Matthew, Aucejo, Federico, Naffouje, Samer
Format: Article
Language:English
Subjects:
Cholangiocarcinoma
intrahepatic cholangiocarcinoma
neoadjuvant therapy
node positivity
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Summary:Background Neoadjuvant systemic therapy (NAST) is a treatment option for intrahepatic cholangiocarcinoma (iCCA), though its impact on short‐term oncologic outcomes and long‐term survival remains relatively unknown. Methods The National Cancer Database (NCDB) between 2004 and 2019 was queried for patients with reportedly resectable (Stage I−IIIB) iCCA who received curative‐intent resection with lymphadenectomy. Propensity matching was performed between groups based on the use of NAST and groups were compared for overall survival (OS) and oncologic outcomes, including nodal harvest, rate of node positivity, rate of positive margins, and administration of adjuvant therapy. Results Two thousand and five hundred ninety‐six patients met inclusion criteria; 364 (14%) received NAST versus 1763 (68%) up‐front resection. After matching, 332 pairs of patients were matched between NAST and no NAST. Patients receiving NAST had a greater nodal harvest (OR = 1.26 [1.09−1.88]; p 
ISSN:0022-4790
1096-9098
1096-9098
DOI:10.1002/jso.27743