E269: Neoadjuvant Chemotherapy in Resected Cholangiocarcinoma: Insights from the National Cancer Database

ePoster Abstract Author(s)

Salvador Rodriguez Franco, MD (he/him/his)

Senior Research Associate
University of Colorado Anschutz Medical Campus
Aurora, Colorado, United States

Submitter(s)

Salvador Rodriguez Franco, MD (he/him/his)

Senior Research Associate
University of Colorado Anschutz Medical Campus
Aurora, Colorado, United States

Author(s)

Salvador Rodriguez Franco, MD (he/him/his)

Senior Research Associate
University of Colorado Anschutz Medical Campus
Aurora, Colorado, United States
SG

Sumaya Abdul Ghaffar, MD

Research Fellow
University of Colorado, United States
Andrii Khomiak, MD

Resident - General Surgery
University of Colorado Anschutz Medical Campus, United States
RW

Reed Weiss, RN, NP

Senior Instructor
University of Colorado Anschutz Medical Campus, United States
MH

Mona Hamermesh, PA

Senior Instructor
University of Colorado Anschutz Medical Campus, United States
BM

Benedetto Mungo, MD

Assistant Professor of Surgery
University of Colorado, Department of Surgery, United States
MD

Marco Del Chiaro, MD, PhD

Division Chief Surgical Oncology
University of Colorado Anschutz Medical Campus, United States
RS

Richard D. Schulick, MD, MBA

Chair of Surgery and Cancer Center Director
University of Colorado, Department of Surgery, United States
AG

Ana L. Gleisner, MD, PhD

Associate Professor of Surgery
University of Colorado, United States

Introduction: While prior clinical trials have highlighted limited responses to adjuvant chemotherapy in the treatment of cholangiocarcinoma, there has been a pivot toward investigating the neoadjuvant strategy. However, there is currently limited data on the long-term outcomes of this approach.

Methods:

Data was extracted from the National Cancer Database (NCDB) for patients who underwent surgery for intrahepatic (iCCA), and perihilar CCA (hCCA) from 2006 to 2020. Patients in this cohort either had upfront surgery or neoadjuvant chemotherapy (NAC) +/- adjuvant therapy. Perioperative mortality and overall survival were compared between these treatment approaches. Cox proportional hazards model was used to adjust for other known prognostic factors.

Results:

From the 6,536 patients who met the criteria, 5,281 had iCCA (80.8%), and 1,254 had hCCA (19.2%). Neoadjuvant chemotherapy was used in 14.5% of the iCCA patients and 8.9% of the hCCA cases. Use of NAC increased from 8.6% in 2006 to 16.8% in 2020. Perioperative mortality was lower in the NAC group (iCCA 3.7% vs. 2.9%; hCCA 7.9% vs. 3.6%, p=0.019). After adjusting for demographics, institutional factors, and tumor characteristics, patients who underwent NAC had improved survival compared to those who underwent upfront surgery, both for iCCA (HR 0.81 [CI 95% 0.71-0.91]) and hCCA (HR 0.66 [CI 95% 0.50-0.88]) (Figure 1).

Conclusions:

Our analysis underscores an uptrend in using NAC for treating both iCCA and hCCA, although this strategy is still used in a minority of these patients. The neoadjuvant approach may help select the patients more likely to benefit from surgical resection without increasing the risk of perioperative mortality.

Learning Objectives:

Upon completion, participants will be able to describe the historical shift from the “surgery-first" approach to the exploration of neoadjuvant chemotherapy in treating cholangiocarcinoma.
Upon completion, participants will be able to list the key findings related to perioperative mortality rates and survival outcomes between patients undergoing neoadjuvant chemotherapy and those having upfront surgery
Upon completion, participants will be able to demonstrate an understanding of the potential advantages of neoadjuvant chemotherapy, emphasizing its potential in selecting patients most likely to benefit from surgical resection