TY - JOUR
T1 - Clinical outcomes for hilar and extrahepatic cholangiocarcinoma with adjuvant, definitive, or liver transplant-based neoadjuvant chemoradiotherapy strategies
T2 - a single-center experience
AU - Laughlin, Brady S.
AU - Petersen, Molly M.
AU - Yu, Nathan Y.
AU - Anderson, Justin D.
AU - Rule, William G.
AU - Borad, Mitesh J.
AU - Aqel, Bashar A.
AU - Sonbol, Mohamad B.
AU - Mathur, Amit K.
AU - Moss, Adyr A.
AU - Bekaii-Saab, Tanios S.
AU - Ahn, Daniel H.
AU - DeWees, Todd A.
AU - Sio, Terence T.
AU - Ashman, Jonathan B.
N1 - Funding Information:
Peer Review File: Available at https://jgo.amegroups.com/ article/view/10.21037/jgo-21-615/prf Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups. com/article/view/10.21037/jgo-21-615/coif). DHA is an advisor for Genentech, Eisai, Advanced Accelerator Applications, Exelixis, and Daiichi Sankyo. TTS provides strategic and scientific recommendations as a member of the Advisory Board and speaker for Novocure, Inc., which is not in any way associated with the content presented in this manuscript. TSBS receives research funding from Agios, Arys, Arcus, Atreca, Boston Biomedical, Bayer, Amgen, Merck, Celgene, Lilly, Ipsen, Clovis, Seattle Genetics, Genentech, Novartis, Mirati, Merus, Abgenomics, Incyte, Pfizer, and BMS; has consulting relationships with Ipsen, Arcus, Array Biopharma, Pfizer, Seattle Genetics, Bayer, Genentech, Incyte, Merck, Stemline, AbbVie, Boehringer Ingelheim, Janssen, Eisai, Daichii Sankyo, Natera, TreosBio, Celularity, Exact Science, Sobi, Beigene, Kanaph, Xilis, Astra Zeneca, and Foundation Medicine; participates on the Data Safety Monitoring Boards of Fibrogen, Suzhou Kintor, Astra Zeneca, Exelixis, Lilly, PanCan, and 1Globe; is a member of the Scientific Advisory Boards of Imugene, Immuneering, and Panbela Therapeutics; and has the following patents pending: WO/2018/183488 and WO/2019/055687. The other authors have no conflicts of interest to declare.
Publisher Copyright:
© 2022 AME Publishing Company. All rights reserved.
PY - 2022/2
Y1 - 2022/2
N2 - Background: We report our experience with 3 strategies for treating hilar and extrahepatic cholangiocarcinoma (CCA) including chemoradiotherapy: neoadjuvant chemoradiotherapy (nCRT) and orthotopic liver transplant, surgical resection and adjuvant chemoradiotherapy (aCRT), and definitive chemoradiotherapy (dCRT). Methods: We included patients treated from 1998 through 2019. Kaplan-Meier estimates, log-rank testing, and univariate/multivariate Cox models were used to assess outcomes (local progression-free survival, disease-free survival, and overall survival). Results: Sixty-five patients (nCRT, n=20; aCRT, n=16; dCRT, n=29) met inclusion criteria [median (range) age 65 years (27–84 years)]. Median posttreatment follow-up was 19.1 months (0.8–164.8 months) for all patients and 38.6, 24.3, and 9.0 months for the nCRT, aCRT, and dCRT groups, respectively. At 3 and 5 years, overall survival was 78% and 59% for the nCRT group; 47% and 35%, aCRT group; and 11% and 0%, dCRT group. Compared with the dCRT group, the nCRT group (hazard ratio =0.13, 95% CI: 0.05–0.33) and the aCRT group (hazard ratio =0.29, 95% CI: 0.14–0.64) had significantly improved overall survival (P<0.001). The 5-year local progression-free survival (50% nCRT vs. 30% aCRT vs. 0% dCRT, P<0.001) and 5-year disease-free survival (61% nCRT vs. 30% aCRT vs. 0% dCRT, P=0.01) were significantly better for strategies combined with surgery. Conclusions: Outcomes for patients with extrahepatic CCA were superior for those who underwent nCRT/orthotopic liver transplant or postsurgical aCRT than for patients treated with dCRT. The excellent outcomes after nCRT/orthotopic liver transplant provide additional independent data supporting the validity of this strategy. The poor survival of patients treated with dCRT highlights a need for better therapies when surgery is not possible.
AB - Background: We report our experience with 3 strategies for treating hilar and extrahepatic cholangiocarcinoma (CCA) including chemoradiotherapy: neoadjuvant chemoradiotherapy (nCRT) and orthotopic liver transplant, surgical resection and adjuvant chemoradiotherapy (aCRT), and definitive chemoradiotherapy (dCRT). Methods: We included patients treated from 1998 through 2019. Kaplan-Meier estimates, log-rank testing, and univariate/multivariate Cox models were used to assess outcomes (local progression-free survival, disease-free survival, and overall survival). Results: Sixty-five patients (nCRT, n=20; aCRT, n=16; dCRT, n=29) met inclusion criteria [median (range) age 65 years (27–84 years)]. Median posttreatment follow-up was 19.1 months (0.8–164.8 months) for all patients and 38.6, 24.3, and 9.0 months for the nCRT, aCRT, and dCRT groups, respectively. At 3 and 5 years, overall survival was 78% and 59% for the nCRT group; 47% and 35%, aCRT group; and 11% and 0%, dCRT group. Compared with the dCRT group, the nCRT group (hazard ratio =0.13, 95% CI: 0.05–0.33) and the aCRT group (hazard ratio =0.29, 95% CI: 0.14–0.64) had significantly improved overall survival (P<0.001). The 5-year local progression-free survival (50% nCRT vs. 30% aCRT vs. 0% dCRT, P<0.001) and 5-year disease-free survival (61% nCRT vs. 30% aCRT vs. 0% dCRT, P=0.01) were significantly better for strategies combined with surgery. Conclusions: Outcomes for patients with extrahepatic CCA were superior for those who underwent nCRT/orthotopic liver transplant or postsurgical aCRT than for patients treated with dCRT. The excellent outcomes after nCRT/orthotopic liver transplant provide additional independent data supporting the validity of this strategy. The poor survival of patients treated with dCRT highlights a need for better therapies when surgery is not possible.
KW - Cholangiocarcinoma (CCA)
KW - Extrahepatic cholangiocarcinoma (extrahepatic CCA)
KW - Hilar cholangiocarcinoma (hilar CCA)
KW - Liver transplant
KW - Neoadjuvant chemoradiation
UR - http://www.scopus.com/inward/record.url?scp=85125567276&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85125567276&partnerID=8YFLogxK
U2 - 10.21037/jgo-21-615
DO - 10.21037/jgo-21-615
M3 - Article
AN - SCOPUS:85125567276
VL - 13
SP - 288
EP - 297
JO - Journal of Gastrointestinal Oncology
JF - Journal of Gastrointestinal Oncology
SN - 2078-6891
IS - 1
ER -