Adjuvant chemotherapy can prolong overall survival in patients with early-stage intrahepatic cholangiocarcinoma (CCA) who have had radical resection, according to a new study published in the journal BMC Cancer.

Independent prognostic factors for poor survival outcomes following surgery include high cancer antigen 19–9 (CA 19–9) levels before surgery and nerve invasion, reported Xiao-hui Li, of the Sun Yat-sen University Cancer Center in Guangzhou, China, and colleagues.

Adjuvant chemotherapy is already used following the radical resection of intrahepatic CCA with a high risk of recurrence. However, its use in the treatment of early-stage disease is controversial, the study authors noted.

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Here, a team of researchers from China assessed the potential benefit of adjuvant chemotherapy in patients with early-stage intrahepatic CCA.

They retrospectively analyzed 148 patients who had radical resection to treat early-stage intrahepatic CCA between January 2012 and January 2018. Some patients received adjuvant chemotherapy following the operation, while others did not. For patients who received adjuvant chemotherapy following the operation, they followed 3 regimens: gemcitabine plus capecitabine, gemcitabine plus cisplatin, and capecitabine monotherapy.

The team compared the relapse-free survival and overall survival of the groups. They also evaluated the safety of adjuvant chemotherapy based on the incidence of adverse events.

The results showed that in patients who did not receive adjuvant chemotherapy, the median relapse-free survival was 18 months, while in patients who did receive adjuvant chemotherapy, it went up to 25 months. 

Similarly, adjuvant chemotherapy also improved overall survival among patients, with median overall survival being 34 months among those who did not receive adjuvant chemotherapy.

Using statistical analyses, the researchers identified nerve invasion, the elevation of CA 19–9 levels before the operation, and adjuvant chemotherapy as independent prognostic factors after radical resection in these patients.

The researchers also assessed the overall survival of patients being treated with different adjuvant chemotherapy regimens to patients who did not receive adjuvant chemotherapy. They found that it was higher in patients treated with gemcitabine plus capecitabine compared to those not treated with adjuvant chemotherapy.

The incidence of grade 3 or 4 adverse events was less than 18.2% in patients who received any type of adjuvant chemotherapy regimen. No deaths occurred due to such reactions. 


Li XH, Zhao CY, Zhou EL, Lin XJ. Efficacy and safety of adjuvant chemotherapy in T1N0M0 intrahepatic cholangiocarcinoma after radical resection. BMC Cancer. Published online November 10, 2022. doi:10.1186/s12885-022-10269-0