Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma: A propensity score matched analysis

Authors

Siddhartha Yadav, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA.
Hao Xie, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA.
Irbaz Bin-Riaz, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA.
Prabin Sharma, Department of Gastroenterology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, 06610, USA.
Urshila Durani, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA.
Gaurav Goyal, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA.
Bijan Borah, Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA.
Mitesh J. Borad, Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, 85259, USA.
Rory L. Smoot, Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
Lewis R. Roberts, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA.
Ronald S. Go, Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA.
Robert R. McWilliams, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA.
Amit Mahipal, Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA. Electronic address: Mahipal.Amit@mayo.edu.

Document Type

Article

Publication Title

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

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.

First Page

1432

Last Page

1438

DOI

10.1016/j.ejso.2019.03.023

Publication Date

8-1-2019

Recommended Citation

Yadav, Siddhartha; Xie, Hao; Bin-Riaz, Irbaz; Sharma, Prabin; Durani, Urshila; Goyal, Gaurav; Borah, Bijan; Borad, Mitesh J.; Smoot, Rory L.; Roberts, Lewis R.; Go, Ronald S.; McWilliams, Robert R.; and Mahipal, Amit, "Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma: A propensity score matched analysis" (2019). All Research. 179.
https://scholar.bridgeporthospital.org/all_research/179

Identifier

30914290 (pubmed); 10.1016/j.ejso.2019.03.023 (doi); S0748-7983(19)30351-8 (pii)