The use of neoadjuvant chemotherapy before resection surgery may increase the long-term survival of patients with intrahepatic cholangiocarcinoma (CCA) compared to surgery alone, according to a systematic review and meta-analysis published in BMC Gastroenterology.
The meta-analysis found that patients who received neoadjuvant chemotherapy before surgery had a statistically higher 5-year overall survival (OS) than the patients who only received surgery (odds ratio (OR) 1.27). However, no significant difference was observed in the 1-year and 3-year OS of the 2 groups.
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However, there was a significantly lower rate of R0 resection in the neoadjuvant group compared to the surgery-only group (OR 0.49). There was also a high degree of heterogeneity between the studies included in the meta-analysis with regard to R0 resection.
The authors attributed the lower rate of R0 resection to possible selection bias as the patients in the neoadjuvant group often had more advanced disease or initially unresectable CCA since the studies analyzed were not randomized controlled trials.
“Considering that the patients in the neoadjuvant chemotherapy followed by surgery group had more advanced [intrahepatic CCA] cases, the benefits of neoadjuvant chemotherapy may be more significant in patients with more advanced [intrahepatic CCA],” the authors wrote.
Recurrence-free survival (RFS) rates at 1 year, 3 years, and 5 years were not significantly different between the 2 patient groups. No significant difference was observed in the postoperative complication rate or 90-day postoperative mortality between the groups either.
“Compared with the upfront surgery, neoadjuvant chemotherapy followed by surgery exhibited no significant RFS benefit, but it could prolong the 5-year OS of the [intrahepatic CCA] patients without increasing the risk of postoperative complications,” the authors wrote.
After a comprehensive literature search, a total of 5 studies were identified and included in the meta-analysis. The 5 studies included a total of 2412 patients, with 2 studies being performed in the US, 2 in France, and 1 that was multicentered.
Reference
Yang Z, Jiang X. Efficacy and safety comparison of neoadjuvant chemotherapy followed by surgery and upfront surgery for treating intrahepatic cholangiocarcinoma: a systematic review and meta-analysis. BMC Gastroenterol. Published online April 12, 2023. doi:10.1186/s12876-023-02754-y
