Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?

Bibliographic Details
Main Author: Tsilimigras, DI
Publication Date: 2021
Other Authors: Hyer, JM, Paredes, AZ, Moris, D, Sahara, K, Guglielmi, A, Aldrighetti, L, Weiss, M, Bauer, TW, Alexandrescu, S, Poultsides, GA, Maithel, SK, Pinto Marques, H, Martel, G, Pulitano, C, Shen, F, Soubrane, O, Koerkamp, BG, Endo, I, Sasaki, K, Aucejo, F, Zhang, XF, Pawlik, TM
Format: Article
Language: eng
Source: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Download full: http://hdl.handle.net/10400.17/4263
Summary: Introduction: While tumor burden (TB) has been associated with outcomes among patients with hepatocellular carcinoma, the role of overall TB in intrahepatic cholangiocarcinoma (ICC) remains poorly defined. Methods: Patients undergoing curative-intent resection of ICC between 2000 and 2017 were identified from a multi-institutional database. The impact of TB on overall (OS) and disease-free survival (DFS) was evaluated in the multi-institutional database and validated externally. Results: Among 1101 patients who underwent curative-intent resection of ICC, 624 (56.7%) had low TB, 346 (31.4%) medium TB, and 131 (11.9%) high TB. OS incrementally worsened with higher TB (5-year OS; low TB: 48.3% vs medium TB: 29.8% vs high TB: 17.3%, p < 0.001). Similarly, patients with low TB had better DFS compared with medium and high TB patients (5-year DFS: 38.3% vs 18.7% vs 6.9%, p < 0.001). On multivariable analysis, TB was independently associated with OS (medium TB: HR = 1.40, 95% CI 1.14-1.71; high TB: HR = 1.89, 95% CI 1.46-2.45) and DFS (medium TB, HR = 1.61, 95% CI 1.33-1.96; high TB: HR = 2.03, 95% CI 1.56-2.64). Survival analysis revealed an excellent prognostic discrimination using the TB among the external validation cohort (3-year OS; low TB: 44.8%, medium TB: 29.3%; high TB: 23.3%, p = 0.03; 3-year DFS: low TB: 32.7%, medium TB: 10.7%; high TB: 0%, p < 0.001). While neoadjuvant chemotherapy was not associated with survival across the TB groups, receipt of adjuvant chemotherapy was associated with increased survival among patients with high TB (5-year OS: 24.4% vs 13.4%, p = 0.02). Conclusion: Overall TB dictated prognosis among patients with resectable ICC. TB may be used as a tool to help guide post-resection treatment strategies.
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spelling Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?Bile Duct Neoplasms* / drug therapyBile Duct Neoplasms* / surgeryChemotherapy, AdjuvantHCC CHBPTCholangiocarcinoma* / drug therapyCholangiocarcinoma* / surgeryHumansHepatectomyPrognosisTumor BurdenIntroduction: While tumor burden (TB) has been associated with outcomes among patients with hepatocellular carcinoma, the role of overall TB in intrahepatic cholangiocarcinoma (ICC) remains poorly defined. Methods: Patients undergoing curative-intent resection of ICC between 2000 and 2017 were identified from a multi-institutional database. The impact of TB on overall (OS) and disease-free survival (DFS) was evaluated in the multi-institutional database and validated externally. Results: Among 1101 patients who underwent curative-intent resection of ICC, 624 (56.7%) had low TB, 346 (31.4%) medium TB, and 131 (11.9%) high TB. OS incrementally worsened with higher TB (5-year OS; low TB: 48.3% vs medium TB: 29.8% vs high TB: 17.3%, p < 0.001). Similarly, patients with low TB had better DFS compared with medium and high TB patients (5-year DFS: 38.3% vs 18.7% vs 6.9%, p < 0.001). On multivariable analysis, TB was independently associated with OS (medium TB: HR = 1.40, 95% CI 1.14-1.71; high TB: HR = 1.89, 95% CI 1.46-2.45) and DFS (medium TB, HR = 1.61, 95% CI 1.33-1.96; high TB: HR = 2.03, 95% CI 1.56-2.64). Survival analysis revealed an excellent prognostic discrimination using the TB among the external validation cohort (3-year OS; low TB: 44.8%, medium TB: 29.3%; high TB: 23.3%, p = 0.03; 3-year DFS: low TB: 32.7%, medium TB: 10.7%; high TB: 0%, p < 0.001). While neoadjuvant chemotherapy was not associated with survival across the TB groups, receipt of adjuvant chemotherapy was associated with increased survival among patients with high TB (5-year OS: 24.4% vs 13.4%, p = 0.02). Conclusion: Overall TB dictated prognosis among patients with resectable ICC. TB may be used as a tool to help guide post-resection treatment strategies.Repositório do Centro Hospitalar Universitário de Lisboa Central, EPETsilimigras, DIHyer, JMParedes, AZMoris, DSahara, KGuglielmi, AAldrighetti, LWeiss, MBauer, TWAlexandrescu, SPoultsides, GAMaithel, SKPinto Marques, HMartel, GPulitano, CShen, FSoubrane, OKoerkamp, BGEndo, ISasaki, KAucejo, FZhang, XFPawlik, TM2022-11-07T15:16:21Z20212021-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/4263engAnn Surg Oncol. 2021 Apr;28(4):1970-1978.10.1245/s10434-020-09393-7info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-10-08T06:31:37Zoai:repositorio.chlc.min-saude.pt:10400.17/4263Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:21:35.429372Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
title Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
spellingShingle Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
Tsilimigras, DI
Bile Duct Neoplasms* / drug therapy
Bile Duct Neoplasms* / surgery
Chemotherapy, Adjuvant
HCC CHBPT
Cholangiocarcinoma* / drug therapy
Cholangiocarcinoma* / surgery
Humans
Hepatectomy
Prognosis
Tumor Burden
title_short Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
title_full Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
title_fullStr Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
title_full_unstemmed Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
title_sort Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
author Tsilimigras, DI
author_facet Tsilimigras, DI
Hyer, JM
Paredes, AZ
Moris, D
Sahara, K
Guglielmi, A
Aldrighetti, L
Weiss, M
Bauer, TW
Alexandrescu, S
Poultsides, GA
Maithel, SK
Pinto Marques, H
Martel, G
Pulitano, C
Shen, F
Soubrane, O
Koerkamp, BG
Endo, I
Sasaki, K
Aucejo, F
Zhang, XF
Pawlik, TM
author_role author
author2 Hyer, JM
Paredes, AZ
Moris, D
Sahara, K
Guglielmi, A
Aldrighetti, L
Weiss, M
Bauer, TW
Alexandrescu, S
Poultsides, GA
Maithel, SK
Pinto Marques, H
Martel, G
Pulitano, C
Shen, F
Soubrane, O
Koerkamp, BG
Endo, I
Sasaki, K
Aucejo, F
Zhang, XF
Pawlik, TM
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE
dc.contributor.author.fl_str_mv Tsilimigras, DI
Hyer, JM
Paredes, AZ
Moris, D
Sahara, K
Guglielmi, A
Aldrighetti, L
Weiss, M
Bauer, TW
Alexandrescu, S
Poultsides, GA
Maithel, SK
Pinto Marques, H
Martel, G
Pulitano, C
Shen, F
Soubrane, O
Koerkamp, BG
Endo, I
Sasaki, K
Aucejo, F
Zhang, XF
Pawlik, TM
dc.subject.por.fl_str_mv Bile Duct Neoplasms* / drug therapy
Bile Duct Neoplasms* / surgery
Chemotherapy, Adjuvant
HCC CHBPT
Cholangiocarcinoma* / drug therapy
Cholangiocarcinoma* / surgery
Humans
Hepatectomy
Prognosis
Tumor Burden
topic Bile Duct Neoplasms* / drug therapy
Bile Duct Neoplasms* / surgery
Chemotherapy, Adjuvant
HCC CHBPT
Cholangiocarcinoma* / drug therapy
Cholangiocarcinoma* / surgery
Humans
Hepatectomy
Prognosis
Tumor Burden
description Introduction: While tumor burden (TB) has been associated with outcomes among patients with hepatocellular carcinoma, the role of overall TB in intrahepatic cholangiocarcinoma (ICC) remains poorly defined. Methods: Patients undergoing curative-intent resection of ICC between 2000 and 2017 were identified from a multi-institutional database. The impact of TB on overall (OS) and disease-free survival (DFS) was evaluated in the multi-institutional database and validated externally. Results: Among 1101 patients who underwent curative-intent resection of ICC, 624 (56.7%) had low TB, 346 (31.4%) medium TB, and 131 (11.9%) high TB. OS incrementally worsened with higher TB (5-year OS; low TB: 48.3% vs medium TB: 29.8% vs high TB: 17.3%, p < 0.001). Similarly, patients with low TB had better DFS compared with medium and high TB patients (5-year DFS: 38.3% vs 18.7% vs 6.9%, p < 0.001). On multivariable analysis, TB was independently associated with OS (medium TB: HR = 1.40, 95% CI 1.14-1.71; high TB: HR = 1.89, 95% CI 1.46-2.45) and DFS (medium TB, HR = 1.61, 95% CI 1.33-1.96; high TB: HR = 2.03, 95% CI 1.56-2.64). Survival analysis revealed an excellent prognostic discrimination using the TB among the external validation cohort (3-year OS; low TB: 44.8%, medium TB: 29.3%; high TB: 23.3%, p = 0.03; 3-year DFS: low TB: 32.7%, medium TB: 10.7%; high TB: 0%, p < 0.001). While neoadjuvant chemotherapy was not associated with survival across the TB groups, receipt of adjuvant chemotherapy was associated with increased survival among patients with high TB (5-year OS: 24.4% vs 13.4%, p = 0.02). Conclusion: Overall TB dictated prognosis among patients with resectable ICC. TB may be used as a tool to help guide post-resection treatment strategies.
publishDate 2021
dc.date.none.fl_str_mv 2021
2021-01-01T00:00:00Z
2022-11-07T15:16:21Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.17/4263
url http://hdl.handle.net/10400.17/4263
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Ann Surg Oncol. 2021 Apr;28(4):1970-1978.
10.1245/s10434-020-09393-7
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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instacron_str RCAAP
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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