Journal ArticleDOI
Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma: A propensity score matched analysis.
Siddhartha Yadav,Hao Xie,Irbaz Bin-Riaz,Prabin Sharma,Urshila Durani,Gaurav Goyal,Bijan J. Borah,Mitesh J. Borad,Rory L. Smoot,Lewis R. Roberts,Ronald S. Go,Robert R. McWilliams,Amit Mahipal +12 more
TLDR
In this article, the authors used the National Cancer Database (NCD) to identify patients who underwent surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and 2014.Abstract:
Background Chemotherapy is frequently used in cholangiocarcinoma as an adjunct to surgical resection, but the appropriate sequence of chemotherapy with surgery is unclear. Patients and methods Using the National Cancer Database, we identified patients who underwent surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and 2014. The propensity score reflecting the probability of receiving neoadjuvant chemotherapy was estimated by multivariate logistic regression method. Patients in the neoadjuvant and adjuvant chemotherapy study arms were then propensity-matched in 1:3 ratios using the nearest neighbor method. Overall Survival (OS) in the matched data set was estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using Cox proportional hazard regression model. Results Of the 1450 patients who met our inclusion criteria, 299 (20.6%) received neoadjuvant chemotherapy while 1151 (79.3%) received adjuvant chemotherapy. The median age at diagnosis was 63 years. 278 patients in the neoadjuvant group were matched to 700 patients in the adjuvant group. In the matched cohort, patients who received neoadjuvant chemotherapy had a superior OS compared to those who received adjuvant chemotherapy (Median OS: 40.3 vs. 32.8 months; HR: 0.78; 95% CI: 0.64–0.94, p = 0.01). The 1- and 5-year OS rates for the neoadjuvant chemotherapy group were 85.8% and 42.5% respectively compared to 84.6% and 31.7% for the adjuvant chemotherapy group. Conclusion In this large national database study, neoadjuvant chemotherapy was associated with a longer OS in a select group of patients with cholangiocarcinoma compared to those who underwent upfront surgical resection followed by adjuvant chemotherapy.read more
Citations
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Journal ArticleDOI
A Machine-Based Approach to Preoperatively Identify Patients with the Most and Least Benefit Associated with Resection for Intrahepatic Cholangiocarcinoma: An International Multi-institutional Analysis of 1146 Patients.
Diamantis I. Tsilimigras,Rittal Mehta,Dimitrios Moris,Kota Sahara,Fabio Bagante,Anghela Z. Paredes,Amika Moro,Alfredo Guglielmi,Luca Aldrighetti,Matthew J. Weiss,Todd W. Bauer,Sorin Alexandrescu,George A. Poultsides,Shishir K. Maithel,Hugo Marques,Guillaume Martel,Carlo Pulitano,Feng Shen,Olivier Soubrane,Bas Groot Koerkamp,Itaru Endo,Timothy M. Pawlik +21 more
TL;DR: A machine-based CART model identified distinct prognostic groups of patients with distinct outcomes based on preoperative factors that may be useful as guides in preoperative patient selection and risk stratification.
Journal ArticleDOI
Current Surgical Management of Peri-Hilar and Intra-Hepatic Cholangiocarcinoma
Andrea Lauterio,Riccardo De Carlis,Leonardo Centonze,Vincenzo Buscemi,Niccolò Incarbone,Ivan Vella,Luciano De Carlis +6 more
TL;DR: In this paper, an aggressive surgical approach, including extended liver resection and vascular reconstruction, and a greater application of systemic therapy and locoregional treatments could lead to an increase in the resection rate and the overall survival in selected intrahepatic cholangiocarcinoma patients.
Journal ArticleDOI
Neoadjuvant treatment strategies for intrahepatic cholangiocarcinoma
TL;DR: The delivery of systemic and/or liver-directed therapies prior to surgery may increase the proportion of patients who are eligible for surgery and reduce recurrence rates by prioritizing early systemic therapy for this aggressive cancer.
Journal ArticleDOI
Neoadjuvant therapy for cholangiocarcinoma: A comprehensive literature review
Alessandro Rizzo,Giovanni Brandi +1 more
TL;DR: In this article, the authors discuss available data on neoadjuvant systemic therapy in cholangiocarcinoma (CCA), highlighting future directions in this setting, with a particular focus on recently published data and ongoing and recruiting trials.
Journal ArticleDOI
Neoadjuvant Chemotherapy for Intrahepatic Cholangiocarcinoma: A Propensity Score Survival Analysis Supporting Use in Patients with High-Risk Disease
Ovie Utuama,Jennifer B. Permuth,Getachew A. Dagne,Aurora Sanchez-Anguiano,Amy C. Alman,Ambuj Kumar,Jason W. Denbo,Richard Kim,Jason B. Fleming,Daniel A. Anaya +9 more
TL;DR: In this paper, the authors examined the use of neoadjuvant chemotherapy (NAC) as an alternative strategy for this population and found that NAC is associated with improved overall survival over upfront surgery in patients with resectable intrahepatic cholangiocarcinoma (ICC) and high risk of treatment failure.
References
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TL;DR: MatchIt implements a wide range of sophisticated matching methods, making it possible to greatly reduce the dependence of causal inferences on hard-to-justify, but commonly made, statistical modeling assumptions.
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Daniel J. Boffa,Joshua E. Rosen,Katherine Mallin,Ashley Loomis,Bryan E. Palis,Kathleen K. Thoburn,Donna M. Gress,Daniel P. McKellar,Lawrence N. Shulman,Lawrence N. Shulman,Matthew A. Facktor,David P. Winchester +11 more
TL;DR: The National Cancer Database offers a critically important perspective on cancer care in the United States and investigators and their audiences should familiarize themselves with the advantages and shortcomings of the NCDB as well as its evolution over time.
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Is Postoperative Adjuvant Chemotherapy Useful for Gallbladder Carcinoma? A Phase III Multicenter Prospective Randomized Controlled Trial in Patients with Resected Pancreaticobiliary Carcinoma
Tadahiro Takada,Hodaka Amano,Hideki Yasuda,Yuji Nimura,Takashi Matsushiro,Hiroyuki Kato,Takukazu Nagakawa,Toshimichi Nakayama +7 more
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Journal Article
Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial
John P. Neoptolemos,Malcolm J. Moore,Trevor Cox,Juan W. Valle,Daniel H. Palmer,Alec McDonald,Rodney William Carter,Niall C. Tebbutt,Christos Dervenis,D. Smith,Bengt Glimelius,Richard Charnley,François Lacaine,Scarfe Ag,Middleton,Alan Anthoney,Paula Ghaneh,Christopher Halloran,Markus M. Lerch,Attila Oláh,Charlotte L. Rawcliffe,Caroline S. Verbeke,Fiona Campbell,M.W. Büchler +23 more
TL;DR: Among patients with resected periampullary adenocarcinoma, adjuvant chemotherapy, compared with observation, was not associated with a significant survival Benefit in the primary analysis; however, multivariable analysis adjusting for prognostic variables demonstrated a statistically significant survival benefit associated with adjuant chemotherapy.
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