Patients with intrahepatic cholangiocarcinoma (CCA) normally undergo surgery, specifically hepatectomy. Wang and colleagues aimed to define how adjuvant treatment with transarterial chemoembolization (TACE) enhanced these patients’ overall survival, with a systematic review and meta-analysis study published in the Journal of Gastrointestinal and Liver Diseases.

Hepatectomy remains the most powerful therapy for curative treatment of CCA; nevertheless, there is limited overall survival and recurrence-free survival in these patients, conferring them a poor prognosis. 

Several adjuvant therapies, including TACE, have been widely used to improve survival and diminish the recurrence of CCA. This study was needed to establish the benefits of using this therapy alone or with chemotherapy after hepatectomy.


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In several databases, the authors looked for studies fulfilling the inclusion criteria until August 2021, including a final 11 studies with almost 2800 patients. The most critical primary outcomes were overall survival and recurrence-free survival. They also did subgroup analysis, including early-stage intrahepatic CCA and patients receiving an intra-arterial chemotherapeutic regimen. 

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Overall survival had a hazard ratio (HR) of 0.68, whereas the HR of recurrence-free survival was not statistically significant. Therefore, TACE improved overall survival but did not enhance recurrence-free survival.

Regarding the subgroup analysis, TACE after hepatectomy enhanced overall survival in patients with early-stage intrahepatic CCA with an HR of 0.68. The addition of carboplatin slightly improved the HR to 0.6. Still, neither TACE nor the use of carboplatin could improve recurrence-free survival in patients with early-stage intrahepatic CCA. 

Based on these results, the authors determined that overall survival was similar regardless of carboplatin use. “Addition or non-addition of carboplatin in chemoembolization showed a similar OS outcome,” they noted.

“This systematic evaluation and meta-analysis showed a survival benefit of postoperative adjuvant TACE in patients with ICC after surgical resection compared with hepatectomy alone,” the authors concluded. Although adjuvant treatment with TACE after hepatectomy improved overall survival, it could not stop disease recurrence. 

Reference

Wang L, Wen X, Zhuang L, Fang K, Shen J. Adjuvant transarterial chemoembolization for patients with intrahepatic cholangiocarcinoma after surgical resection: a systematic review and meta-analysis. J Gastrointestin Liver Dis. Published online May 15, 2022. doi:10.15403/JGLD-4207