title: Chemotherapy for Surgically Resected Intrahepatic Cholangiocarcinoma.
abstract: BACKGROUND
  The benefit of chemotherapy for surgically resected intrahepatic cholangiocarcinoma (ICC) remains poorly defined. The present study sought to determine the survival impact of chemotherapy for surgically resected ICC.
  
  
  METHODS
  Patients with non-metastatic ICC who underwent surgery were identified from the National Cancer Database (1998-2011) and stratified by receipt of chemotherapy. Survival outcomes were analyzed following propensity score modeling using the greedy matching algorithm.
  
  
  RESULTS
  A total of 2751 patients were identified (median age 64 years); 985 (35.8 %) received chemotherapy. Younger age, advanced tumor stage, R1/R2 surgical margins, and lymph node metastasis were all independently associated with receipt of chemotherapy (p < 0.05). Following propensity score matching, advanced tumor stage, lymph node metastasis, poorly differentiated tumors, and R1/R2 surgical margins were associated with poorer overall survival (OS) (p < 0.05). Median OS comparing patients who received chemotherapy compared with surgery alone was 23 versus 20 months (p = 0.09). However, when stratified by lymph node status, chemotherapy demonstrated a significant improvement in median OS among N1 patients (19.8 vs. 10.7 months; p < 0.001). In contrast, patients with N0 disease derived no benefit from chemotherapy (29.4 vs. 29 months; p = 0.33). Additional tumor characteristics associated with improved survival with chemotherapy included T3/T4 tumors (21.3 vs. 15.6 months; p < 0.001) and R1/R2 surgical margins (19.5 vs. 11.6 months; p = 0.006).
  
  
  CONCLUSIONS
  The use of chemotherapy was associated with a survival benefit only for ICC patients with nodal metastasis, advanced tumor stage, or an inadequate surgical resection. Chemotherapy for resected ICC should be strongly considered for tumors harboring high-risk features.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. jmiura@mcw.edu.
authors.forename: John T
authors.initials: JT
authors.lastname: Miura
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.affiliation: Division of Medical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: George
authors.affiliation: Division of Medical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Eastwood
authors.affiliation: Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Anjishnu
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.affiliation: Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. tcgamblin@mcw.edu.
authors.forename: T
authors.initials: T
authors.lastname: Clark Gamblin
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents