Survival outcomes in patients with non-metastatic intrahepatic cholangiocarcinoma in United States: A nationwide analysis.

Abstract

e16277 Background: Intrahepatic cholangiocarcinoma (ICC) is one of the most aggressive primary liver malignancies contributing to notable morbidity and mortality. Surgical resection (Sx) is the mainstay of treatment for non-metastatic ICC. However, it is unclear if augmenting resection with chemotherapy (CT), radiotherapy (RT) or chemoradiation (CRT) confers survival benefit in non-metastatic ICC. This study aims to assess effective therapeutic option for non-metastatic ICC. Methods: We queried the National Cancer Database to identify patients diagnosed with non-metastatic (stage 0-3, M0) ICC between 2004 and 2020. We reported survival outcomes in the study cohort in concordance with STROBE guidelines. We analyzed median overall survival (mOS) and differences in survival using the Kaplan-Meier (KM) methodology and pair-wise log-rank test, respectively in 6 groups based on treatment: Sx, CT, RT, Sx+CT, Sx+CRT, and CRT. Results: The analysis included 20,005 patients diagnosed with non-metastatic ICC with a median age of 66 years (range: 15-90+ years). The population included White (83.6%), Black (8.3%), and Asian (3.9%). 50% of the patients were male, 91.9% were non-Hispanic, 88.8% had Charlson-Deyo score (CDS) of 0-1, 11.2% had CDS ≥2, 51.6% were treated at academic/tertiary care program. 24.0% of the cases had positive lymph nodes. 3,394 patients (23.9%) of the total patients underwent Sx, 4,313 (30.4%) patients underwent CT alone, 1,023 (7.2%) patients underwent RT, 2753 (19.3%) patients underwent Sx+CT, 1100 (7.7%) patients underwent Sx+CRT, and 1629 (11.5%) patients underwent CRT alone. Patients who underwent Sx alone had better mOS (46.3 months, 95% CI 42.8-48.9) than all other modalities, including Sx+CT (46.0 months, 95% CI 43.9-48.0, P = 0.10), Sx+CRT (44.5 months, 95% CI 35.6-50.4, P = 0.11), CT (12.4 months, 95% CI 11.9-12.8, P < 0.01), RT (18.3 months, 95% CI 16.3-19.8, P < 0.01), and CRT (18.1 months, 95% CI 17.0-19.4, P < 0.01). Conclusions: Our study indicates that surgical resection yields the best survival outcomes when compared to other treatment modalities for nonmetastatic ICC. However, there is no significant difference in survival when surgery is combined with chemotherapy or chemoradiation in nonmetastatic ICC. Further prospective research is needed to refine treatment strategies and enhance outcomes for ICC patients. [Table: see text]