Firas Baidoun, MD, Mayo Clinic Florida, Jacksonville, FL, discusses an abstract he presented at the 2023 ASCO Gastrointestinal Cancers Symposium in San Francisco, California investigating the impact of neo/adjuvant chemotherapy among patients with non-metastatic cholangiocarcinoma undergoing surgery.

Dr Baidoun reported, “In our study we found that adjuvant and neoadjuvant chemotherapy did not add much benefit for survival in stage I and II, whereas neoadjuvant chemotherapy seems to add a survival benefit in stage III.”

Transcript:

Hello, my name is Firas Baidoun. I'm a Hematology Oncology Fellow at Mayo Clinic Florida. I am excited to talk about our abstract that I presented at ASCO Gastrointestinal Cancers Symposium in 2023, titled, “The Impact of Peri-operative Chemotherapy on the Outcomes of Patients with Non-metastatic Cholangiocarcinoma.”

As we know, cholangiocarcinoma is a rare malignancy with poor outcome and prognosis. It accounts for about 2% of all cancer cases, and 5% of all cancer deaths. Surgical resection is still the main treatment in this malignancy, whereas the role of chemotherapy is still debatable.

We used in our study National Cancer Database, to include adult patients who were diagnosed with non-metastatic cholangiocarcinoma between 2004 and 2019. We excluded patients with unknown timing of chemotherapy and surgery, patients who died within 90 days of surgery, and patients who lost follow up. Then we split the cohort into 3 main groups based on the clinical stage: stage I, II, and III.

We evaluated the overall survival between the 3 main treatment regimens: surgical resection, only adjuvant chemotherapy vs new adjuvant chemotherapy in each stage. We studied the overall survival using Kaplan-Meier estimates, and we use multivariate Cox regression analysis to evaluate factors associated with overall survival.

In our study, we had a total of 35,260 patients with non-metastatic cholangiocarcinoma, of which 50% were females, 83% Caucasians, and 10% African Americans. The median age at diagnosis was 70. Among all the cohorts, 42% had stage I at the time of diagnosis. 35% had stage II, and 23% had stage III. 21% received surgery only. 23% had chemotherapy only, 20% had surgical resection and perioperative chemotherapy, whereas 37% did not receive any type of treatment.

We compared the overall survival between the 3 different treatment modalities in each clinical stage group. In stage I, we found patients who were received or were treated with surgery only, had better median overall survival compared to patients who received adjuvant chemotherapy. Median overall survival was 65.7 months for patients who received surgery only vs 50.4 months in patients who received adjuvant chemotherapy. And we did not see any significant difference in the overall survival between patients who received surgery only, versus patient who received neoadjuvant chemotherapy. Median overall survival was 65.7 months in the surgery only group, versus 79.8 months in the neoadjuvant group, with the P-value of 0.63.

In stage II the story was a little bit different. We found that patients who received adjuvant and neoadjuvant chemotherapy had better median overall survival compared to patients who had surgery only. The median overall survival was 33.9 months in the adjuvant group vs 40.3 months in the neoadjuvant group vs 29.9 months in the surgery only group.

The same trend was seen in stage III as well. Patients who were treated with adjuvant and neoadjuvant chemotherapy had better median overall survival compared to patient who had surgery only. The median overall survival was 22.6 months in the adjuvant therapy, 41.5 months in the neoadjuvant group, and 19.5 months in the surgery only group.

In multivariate analysis, we found that adjuvant and neoadjuvant chemotherapy did not affect the overall survival in all stages, with one exception. We found that neoadjuvant chemotherapy was associated with better overall survival in stage III.

In conclusion, cholangiocarcinoma is a rare malignancy with poor outcome and prognosis. Surgical resection is still the cornerstone treatment in this disorder, whereas the role of perioperative chemotherapy is still debatable. In our study, we found that adjuvant and neoadjuvant chemotherapy did not add much benefit for survival in stage I or stage II. Whereas neoadjuvant chemotherapy seems to add survival benefit in stage III.

Thank you so much.

Source:

Baidoun F, Moustafa MA, and Abden-Rahman O. The impact of peri-operative chemotherapy on the outcomes of patients with non-metastatic cholangiocarcinoma. J Clin Oncol. 2023;41(4_suppl):563. doi:10.1200/JCO.2023.41.4_suppl.563