Grace C Lee1, Cristina R Ferrone2, Kenneth K Tanabe2, Keith D Lillemoe1, Lawrence S Blaszkowsky3, Andrew X Zhu4, Theodore S Hong5, Motaz Qadan6. 1. Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Newton Wellesley Hospital, Newton, MA 02462, USA. 2. Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA. 3. Newton Wellesley Hospital, Newton, MA 02462, USA; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA. 4. Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA. 5. Newton Wellesley Hospital, Newton, MA 02462, USA; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA. 6. Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Newton Wellesley Hospital, Newton, MA 02462, USA. Electronic address: MQADAN@mgh.harvard.edu.
Abstract
BACKGROUND: Administration of adjuvant therapy (AT) in patients with intrahepatic cholangiocarcinoma (ICC) remains inconsistent despite recent trial data. This study investigates predictors of receipt of AT and survival. METHODS: Patients with ICC who underwent resection were identified using the NCDB (2004-2014). Logistic regression and Cox analysis were used to determine predictors of AT and survival, respectively. "High-risk" was defined as positive margins/nodes or stage III/IVa disease. RESULTS: 2813 patients were identified, of whom 42.3% received AT. Patients with positive margins, positive nodes, and higher stage tended to receive AT (p < 0.001). Black patients and patients with Medicare/Medicaid were less likely to receive AT. In "high-risk" patients, AT was associated with lower mortality (HR 0.66, 95% CI 0.56-0.78, p < 0.001). CONCLUSIONS: AT after ICC resection is associated with improved survival in patients with positive margins, positive nodes, and stage III/IVa disease. There are disparities and regional variations in the receipt of AT.
BACKGROUND: Administration of adjuvant therapy (AT) in patients with intrahepatic cholangiocarcinoma (ICC) remains inconsistent despite recent trial data. This study investigates predictors of receipt of AT and survival. METHODS:Patients with ICC who underwent resection were identified using the NCDB (2004-2014). Logistic regression and Cox analysis were used to determine predictors of AT and survival, respectively. "High-risk" was defined as positive margins/nodes or stage III/IVa disease. RESULTS: 2813 patients were identified, of whom 42.3% received AT. Patients with positive margins, positive nodes, and higher stage tended to receive AT (p < 0.001). Black patients and patients with Medicare/Medicaid were less likely to receive AT. In "high-risk" patients, AT was associated with lower mortality (HR 0.66, 95% CI 0.56-0.78, p < 0.001). CONCLUSIONS: AT after ICC resection is associated with improved survival in patients with positive margins, positive nodes, and stage III/IVa disease. There are disparities and regional variations in the receipt of AT.
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