Predictors of adjuvant treatment and survival in patients with intrahepatic cholangiocarcinoma who undergo resection

Abstract

Background: Administration of adjuvant therapy (AT) in patients with intrahepatic cholangiocarcinoma (ICC) remains inconsistent despite recent trial data. This study investigates predictors of receipt of AT and survival.

Methods: Patients with ICC who underwent resection were identified using the NCDB (2004-2014). Logistic regression and Cox analysis were used to determine predictors of AT and survival, respectively. "High-risk" was defined as positive margins/nodes or stage III/IVa disease.

Results: 2813 patients were identified, of whom 42.3% received AT. Patients with positive margins, positive nodes, and higher stage tended to receive AT (p < 0.001). Black patients and patients with Medicare/Medicaid were less likely to receive AT. In "high-risk" patients, AT was associated with lower mortality (HR 0.66, 95% CI 0.56-0.78, p < 0.001).

Conclusions: AT after ICC resection is associated with improved survival in patients with positive margins, positive nodes, and stage III/IVa disease. There are disparities and regional variations in the receipt of AT.

Keywords: Adjuvant therapy; Chemotherapy; Disparities; Intrahepatic cholangiocarcinoma; Regional variation.