Patients with cholangiocarcinoma (CCA) undergoing curative intent surgery appear to have prolonged overall survival and disease-free survival if they receive perioperative chemotherapy, according to a recently published study in the European Journal of Surgical Oncology.

CCA incidence has significantly risen in recent decades. Despite increased research in the area, the prognosis remains poor as the majority of patients are diagnosed at advanced stages. Furthermore, patients eligible for surgical resection often experience recurrence.

Currently, systemic therapy in the form of adjuvant capecitabine is the standard of care for patients who undergo curative intent surgery; however, the effectiveness of this regimen has only been tested in patients who underwent up-front resection. The effectiveness of combined neoadjuvant therapy and adjuvant therapy (perioperative chemotherapy) in patients with borderline resectable disease has not yet been analyzed.


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The authors of the present study aimed to analyze the impact of perioperative chemotherapy through a retrospective study including data from 182 patients who underwent curative intent surgery for CCA between 2000 and 2019, of which 54% received surgery alone and 46% had surgery and perioperative chemotherapy. The authors used Cox proportional hazard modeling to determine the impact of perioperative chemotherapy on overall survival and disease-free survival.

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Results revealed that median disease-free survival was prolonged in patients receiving perioperative chemotherapy, with a mean disease-free survival of 2.5 years compared to 1.7 years in patients who received surgery alone. Similarly, patients who received perioperative chemotherapy experienced a statistically significant improvement in overall survival compared to patients who received therapy alone.

“The study demonstrated statistically significant improvement in [disease-free survival] and [overall survival] on multivariate analysis with the administration of [perioperative chemotherapy] in patients with resected CCA,” the authors wrote.

They noted that lymph node involvement and positivity of surgical margins could also impact the prognosis of patients receiving preoperative chemotherapy, suggesting that the benefits of perioperative chemotherapy are not observed uniformly, as it benefits particular subgroups of patients.

Reference

Hassan H, Chakrabarti S, Zemla T, et al. Impact of perioperative chemotherapy on survival in patients with cholangiocarcinoma undergoing curative resection. Eur J Surg Oncol. Published online July 25, 2023. doi:10.1016/j.ejso.2023.106994