Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma

A propensity score matched analysis

Siddhartha Yadav, Hao Xie, Irbaz Bin-Riaz, Prabin Sharma, Urshila Durani, Gaurav Goyal, Bijan J Borah, Mitesh J Borad, Rory Smoot, Lewis Rowland Roberts, Ronald S. Go, Robert R Mc Williams, Amit Mahipal

Research output: Contribution to journalArticle

Abstract

Background: Chemotherapy is frequently used in cholangiocarcinoma as an adjunct to surgical resection, but the appropriate sequence of chemotherapy with surgery is unclear. Patients and methods: Using the National Cancer Database, we identified patients who underwent surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and 2014. The propensity score reflecting the probability of receiving neoadjuvant chemotherapy was estimated by multivariate logistic regression method. Patients in the neoadjuvant and adjuvant chemotherapy study arms were then propensity-matched in 1:3 ratios using the nearest neighbor method. Overall Survival (OS) in the matched data set was estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using Cox proportional hazard regression model. Results: Of the 1450 patients who met our inclusion criteria, 299 (20.6%) received neoadjuvant chemotherapy while 1151 (79.3%) received adjuvant chemotherapy. The median age at diagnosis was 63 years. 278 patients in the neoadjuvant group were matched to 700 patients in the adjuvant group. In the matched cohort, patients who received neoadjuvant chemotherapy had a superior OS compared to those who received adjuvant chemotherapy (Median OS: 40.3 vs. 32.8 months; HR: 0.78; 95% CI: 0.64–0.94, p = 0.01). The 1- and 5-year OS rates for the neoadjuvant chemotherapy group were 85.8% and 42.5% respectively compared to 84.6% and 31.7% for the adjuvant chemotherapy group. Conclusion: In this large national database study, neoadjuvant chemotherapy was associated with a longer OS in a select group of patients with cholangiocarcinoma compared to those who underwent upfront surgical resection followed by adjuvant chemotherapy.

Original languageEnglish (US)
JournalEuropean Journal of Surgical Oncology
DOIs
StatePublished - Jan 1 2019

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Propensity Score
Cholangiocarcinoma
Adjuvant Chemotherapy
Drug Therapy
Survival
Databases
Proportional Hazards Models
Research Design
Survival Rate
Logistic Models

Keywords

  • Adjuvant
  • Chemotherapy
  • Cholangiocarcinoma
  • Neoadjuvant
  • Surgery
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma : A propensity score matched analysis. / Yadav, Siddhartha; Xie, Hao; Bin-Riaz, Irbaz; Sharma, Prabin; Durani, Urshila; Goyal, Gaurav; Borah, Bijan J; Borad, Mitesh J; Smoot, Rory; Roberts, Lewis Rowland; Go, Ronald S.; Mc Williams, Robert R; Mahipal, Amit.

In: European Journal of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Chemotherapy is frequently used in cholangiocarcinoma as an adjunct to surgical resection, but the appropriate sequence of chemotherapy with surgery is unclear. Patients and methods: Using the National Cancer Database, we identified patients who underwent surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and 2014. The propensity score reflecting the probability of receiving neoadjuvant chemotherapy was estimated by multivariate logistic regression method. Patients in the neoadjuvant and adjuvant chemotherapy study arms were then propensity-matched in 1:3 ratios using the nearest neighbor method. Overall Survival (OS) in the matched data set was estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using Cox proportional hazard regression model. Results: Of the 1450 patients who met our inclusion criteria, 299 (20.6{\%}) received neoadjuvant chemotherapy while 1151 (79.3{\%}) received adjuvant chemotherapy. The median age at diagnosis was 63 years. 278 patients in the neoadjuvant group were matched to 700 patients in the adjuvant group. In the matched cohort, patients who received neoadjuvant chemotherapy had a superior OS compared to those who received adjuvant chemotherapy (Median OS: 40.3 vs. 32.8 months; HR: 0.78; 95{\%} CI: 0.64–0.94, p = 0.01). The 1- and 5-year OS rates for the neoadjuvant chemotherapy group were 85.8{\%} and 42.5{\%} respectively compared to 84.6{\%} and 31.7{\%} for the adjuvant chemotherapy group. Conclusion: In this large national database study, neoadjuvant chemotherapy was associated with a longer OS in a select group of patients with cholangiocarcinoma compared to those who underwent upfront surgical resection followed by adjuvant chemotherapy.",
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T1 - Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma

T2 - A propensity score matched analysis

AU - Yadav, Siddhartha

AU - Xie, Hao

AU - Bin-Riaz, Irbaz

AU - Sharma, Prabin

AU - Durani, Urshila

AU - Goyal, Gaurav

AU - Borah, Bijan J

AU - Borad, Mitesh J

AU - Smoot, Rory

AU - Roberts, Lewis Rowland

AU - Go, Ronald S.

AU - Mc Williams, Robert R

AU - Mahipal, Amit

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Chemotherapy is frequently used in cholangiocarcinoma as an adjunct to surgical resection, but the appropriate sequence of chemotherapy with surgery is unclear. Patients and methods: Using the National Cancer Database, we identified patients who underwent surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and 2014. The propensity score reflecting the probability of receiving neoadjuvant chemotherapy was estimated by multivariate logistic regression method. Patients in the neoadjuvant and adjuvant chemotherapy study arms were then propensity-matched in 1:3 ratios using the nearest neighbor method. Overall Survival (OS) in the matched data set was estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using Cox proportional hazard regression model. Results: Of the 1450 patients who met our inclusion criteria, 299 (20.6%) received neoadjuvant chemotherapy while 1151 (79.3%) received adjuvant chemotherapy. The median age at diagnosis was 63 years. 278 patients in the neoadjuvant group were matched to 700 patients in the adjuvant group. In the matched cohort, patients who received neoadjuvant chemotherapy had a superior OS compared to those who received adjuvant chemotherapy (Median OS: 40.3 vs. 32.8 months; HR: 0.78; 95% CI: 0.64–0.94, p = 0.01). The 1- and 5-year OS rates for the neoadjuvant chemotherapy group were 85.8% and 42.5% respectively compared to 84.6% and 31.7% for the adjuvant chemotherapy group. Conclusion: In this large national database study, neoadjuvant chemotherapy was associated with a longer OS in a select group of patients with cholangiocarcinoma compared to those who underwent upfront surgical resection followed by adjuvant chemotherapy.

AB - Background: Chemotherapy is frequently used in cholangiocarcinoma as an adjunct to surgical resection, but the appropriate sequence of chemotherapy with surgery is unclear. Patients and methods: Using the National Cancer Database, we identified patients who underwent surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and 2014. The propensity score reflecting the probability of receiving neoadjuvant chemotherapy was estimated by multivariate logistic regression method. Patients in the neoadjuvant and adjuvant chemotherapy study arms were then propensity-matched in 1:3 ratios using the nearest neighbor method. Overall Survival (OS) in the matched data set was estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using Cox proportional hazard regression model. Results: Of the 1450 patients who met our inclusion criteria, 299 (20.6%) received neoadjuvant chemotherapy while 1151 (79.3%) received adjuvant chemotherapy. The median age at diagnosis was 63 years. 278 patients in the neoadjuvant group were matched to 700 patients in the adjuvant group. In the matched cohort, patients who received neoadjuvant chemotherapy had a superior OS compared to those who received adjuvant chemotherapy (Median OS: 40.3 vs. 32.8 months; HR: 0.78; 95% CI: 0.64–0.94, p = 0.01). The 1- and 5-year OS rates for the neoadjuvant chemotherapy group were 85.8% and 42.5% respectively compared to 84.6% and 31.7% for the adjuvant chemotherapy group. Conclusion: In this large national database study, neoadjuvant chemotherapy was associated with a longer OS in a select group of patients with cholangiocarcinoma compared to those who underwent upfront surgical resection followed by adjuvant chemotherapy.

KW - Adjuvant

KW - Chemotherapy

KW - Cholangiocarcinoma

KW - Neoadjuvant

KW - Surgery

KW - Survival

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DO - 10.1016/j.ejso.2019.03.023

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JO - European Journal of Surgical Oncology

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