Local therapy reduces the risk of liver failure and improves survival in patients with intrahepatic cholangiocarcinoma: A comprehensive analysis of 362 consecutive patients

Abstract

Background: Treatment methods for intrahepatic cholangiocarcinoma (ICC) have improved, but their impact on outcome remains unclear. We evaluated the outcomes of patients definitively treated with resection, radiation, and chemotherapy for ICC, stratified by era.

Methods: Clinico-pathologic characteristics, cause of death, disease-specific survival (DSS), and intrahepatic progression-free survival (IPFS) were compared among patients who underwent resection, radiation, or chemotherapy as definitive treatment strategies for ICC (without distant organ metastasis) between 1997 and 2015. Variables were also analyzed by era (1997-2006 [early] or 2007-2015 [late]) within each group.

Results: Among 362 patients in our cohort, 122 underwent resection (early, 38; late, 84), 85 underwent radiation (early, 17; late, 68), and 148 underwent systemic chemotherapy alone (early, 51; late, 97) as definitive treatment strategies, and 7 patients received best supportive care. In the resection group, the 3-year DSS rate was 58% for the early era and 67% for the late era (P = .036), and the 1-year IPFS was 50% for the early era and 75% for the late era (P = .048). In the radiation group, the 3-year DSS was 12% for the early era and 37% for the late era (P = .048), and the 1-year IPFS was 48% for the early era and 64% for the late era (P = .030). In the chemotherapy group, DSS and IPFS did not differ by era. Patients treated with chemotherapy developed liver failure at the time of death significantly more frequently than patients treated with resection (P < .001) or radiation (P < .001). Multivariable analysis identified local therapy (resection or radiation) as a sole predictor of death without liver failure.

Conclusion: Survival outcomes have improved for local therapy-based definitive treatment strategies for ICC, which may be attributable to maintaining control of intrahepatic disease, thereby reducing the occurrence of death due to liver failure. Cancer 2017;123:1354-1362. © 2016 American Cancer Society.

Keywords: chemotherapy; intrahepatic cholangiocarcinoma; intrahepatic progression-free survival; local therapy; radiation; resection.

Fig 1

Flowchart showing treatments administered in the study population.

Fig 2. Cause of death

Presence and absence of liver failure at the time of death in patients with known causes of death who underwent resection, radiation, or chemotherapy as definitive treatment.

Fig 3. Intrahepatic progression-free survival (IPFS) by treatment group and era

A, IPFS by definitive treatment strategy. B, IPFS in the chemotherapy group by era. C, IPFS in the resection group by era. D, IPFS in the radiation group by era.

Fig 4. Disease-specific survival (DSS) by treatment group and era

A, DSS by definitive treatment strategy. B, DSS in the chemotherapy group by era. C, DSS in the resection group by era. D, DSS in the radiation group by era.