Adjuvant transarterial chemoembolization following liver resection for intrahepatic cholangiocarcinoma based on survival risk stratification

Abstract

Background: The effectiveness of adjuvant transarterial chemoembolization (TACE) for intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study was to identify ICC patients who would benefit from adjuvant TACE. Patients and methods: The study included 553 patients who underwent hepatectomy for ICC between January 2008 and February 2011 at the Eastern Hepatobiliary Surgery Hospital and who were treated with or without TACE (122 and 431 patients in the TACE and non-TACE groups, respectively). Survival risk stratification was performed using the established prognostic nomogram (ICC-nomogram). The predictive performance was evaluated by concordance index (c-index), calibration. The tumor recurrence and overall survival (OS) rates were analyzed by Kaplan-Meier method before and after propensity score matching (PSM). Results: The predictive performance of the ICC nomogram was demonstrated by the well-fitted calibration curves and an optimal c-index of 0.71 for OS prediction. In the whole cohort, the 5-year recurrence and OS rates between the TACE and non-TACE groups were significantly different (72.9% vs. 78.1%; 38.4% vs. 29.7%). After 1:1 PSM, the TACE and non-TACE groups (122 patients each) had similar 5-year recurrence and OS rates (72.9% vs. 74.2%; 38.4% vs. 36.0%). By survival risk stratification based on ICC nomogram, only the patients in the lowest tertile (nomogram scores ≥ 77) benefited from adjuvant TACE (TACE vs. non-TACE groups: 90.4% vs. 95.9% for 5-year recurrence; 21.3% vs. 6.2% for 5-year OS). Conclusion: Adjuvant TACE following liver resection might be suitable for ICC patients with high ICC nomogram scores (≥ 77).