Improved Survival in Surgically Resected Distal Cholangiocarcinoma Treated with Adjuvant Therapy: a Propensity Score Matched Analysis

Caitlin Hester, Ibrahim Nassour, Beverley Adams-Huet, Mathew Augustine, Michael A. Choti, Rebecca M. Minter, John C. Mansour, Patricio M. Polanco, Matthew R. Porembka, Sam C. Wang, Adam C. Yopp

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1 Citation (Scopus)

Abstract

Background: Data on the efficacy of adjuvant therapy (AT) in distal cholangiocarcinoma (dCCA) is limited. This study aimed to determine the role of AT in resected dCCA and identify subgroups that benefit from AT. Methods: We conducted a retrospective review of surgically resected dCCA in the NCDB from 2004 to 2013. Patients who received AT or observation (OB) were matched by propensity score. Log-rank test was used to compare OS. Results: Of 1782 patients with resected dCCA, 840 (47%) were in the OB group and 942 (53%) in the AT group. AT was younger (64.0 vs. 68.7 years, p < 0.001), had less comorbidities (Charlson Deyo score 0) (74.6 vs. 68.0%, p < 0.001), and more likely to have private insurance (p < 0.001). AT was more likely to present with T3/T4 stage (72 vs. 57%, p < 0.001), N1/N2 disease (58 vs. 37%, p < 0.001), and positive surgical margins (26 vs. 16%, p < 0.001). After 1:1 propensity score matching, 500 OB and 500 AT patients were compared. AT was associated with better OS (HR 0.79; 95% CI 0.67–0.93). Median OS was 31 and 25 months for the AT and OB (p = 0.006). The 1-, 3-, and 5-year survival rates were 87, 46, and 31% for AT; 79, 39, and 24% for OB. Subgroup analysis revealed an associated survival advantage for AT in T3/T4 tumors (HR = 0.72; 95% CI 0.59–0.89), node positive disease (HR 0.70; 95% CI 0.56–0.87), and positive margins (HR 0.58; 95% CI 0.42–0.81). Conclusion: AT is associated with improved OS in resected dCCA, especially in T3/T4 tumors, node positive disease, and positive margins.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Propensity Score
Cholangiocarcinoma
Survival
Observation
Therapeutics
Group Psychotherapy
Insurance
Comorbidity
Neoplasms
Survival Rate

Keywords

  • Adjuvant therapy
  • Distal cholangiocarcinoma
  • Extrahepatic
  • Propensity score

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{6a134764b5874c44a42df81796459ccf,
title = "Improved Survival in Surgically Resected Distal Cholangiocarcinoma Treated with Adjuvant Therapy: a Propensity Score Matched Analysis",
abstract = "Background: Data on the efficacy of adjuvant therapy (AT) in distal cholangiocarcinoma (dCCA) is limited. This study aimed to determine the role of AT in resected dCCA and identify subgroups that benefit from AT. Methods: We conducted a retrospective review of surgically resected dCCA in the NCDB from 2004 to 2013. Patients who received AT or observation (OB) were matched by propensity score. Log-rank test was used to compare OS. Results: Of 1782 patients with resected dCCA, 840 (47{\%}) were in the OB group and 942 (53{\%}) in the AT group. AT was younger (64.0 vs. 68.7 years, p < 0.001), had less comorbidities (Charlson Deyo score 0) (74.6 vs. 68.0{\%}, p < 0.001), and more likely to have private insurance (p < 0.001). AT was more likely to present with T3/T4 stage (72 vs. 57{\%}, p < 0.001), N1/N2 disease (58 vs. 37{\%}, p < 0.001), and positive surgical margins (26 vs. 16{\%}, p < 0.001). After 1:1 propensity score matching, 500 OB and 500 AT patients were compared. AT was associated with better OS (HR 0.79; 95{\%} CI 0.67–0.93). Median OS was 31 and 25 months for the AT and OB (p = 0.006). The 1-, 3-, and 5-year survival rates were 87, 46, and 31{\%} for AT; 79, 39, and 24{\%} for OB. Subgroup analysis revealed an associated survival advantage for AT in T3/T4 tumors (HR = 0.72; 95{\%} CI 0.59–0.89), node positive disease (HR 0.70; 95{\%} CI 0.56–0.87), and positive margins (HR 0.58; 95{\%} CI 0.42–0.81). Conclusion: AT is associated with improved OS in resected dCCA, especially in T3/T4 tumors, node positive disease, and positive margins.",
keywords = "Adjuvant therapy, Distal cholangiocarcinoma, Extrahepatic, Propensity score",
author = "Caitlin Hester and Ibrahim Nassour and Beverley Adams-Huet and Mathew Augustine and Choti, {Michael A.} and Minter, {Rebecca M.} and Mansour, {John C.} and Polanco, {Patricio M.} and Porembka, {Matthew R.} and Wang, {Sam C.} and Yopp, {Adam C.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s11605-018-3875-x",
language = "English (US)",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

}

TY - JOUR

T1 - Improved Survival in Surgically Resected Distal Cholangiocarcinoma Treated with Adjuvant Therapy

T2 - a Propensity Score Matched Analysis

AU - Hester, Caitlin

AU - Nassour, Ibrahim

AU - Adams-Huet, Beverley

AU - Augustine, Mathew

AU - Choti, Michael A.

AU - Minter, Rebecca M.

AU - Mansour, John C.

AU - Polanco, Patricio M.

AU - Porembka, Matthew R.

AU - Wang, Sam C.

AU - Yopp, Adam C.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Data on the efficacy of adjuvant therapy (AT) in distal cholangiocarcinoma (dCCA) is limited. This study aimed to determine the role of AT in resected dCCA and identify subgroups that benefit from AT. Methods: We conducted a retrospective review of surgically resected dCCA in the NCDB from 2004 to 2013. Patients who received AT or observation (OB) were matched by propensity score. Log-rank test was used to compare OS. Results: Of 1782 patients with resected dCCA, 840 (47%) were in the OB group and 942 (53%) in the AT group. AT was younger (64.0 vs. 68.7 years, p < 0.001), had less comorbidities (Charlson Deyo score 0) (74.6 vs. 68.0%, p < 0.001), and more likely to have private insurance (p < 0.001). AT was more likely to present with T3/T4 stage (72 vs. 57%, p < 0.001), N1/N2 disease (58 vs. 37%, p < 0.001), and positive surgical margins (26 vs. 16%, p < 0.001). After 1:1 propensity score matching, 500 OB and 500 AT patients were compared. AT was associated with better OS (HR 0.79; 95% CI 0.67–0.93). Median OS was 31 and 25 months for the AT and OB (p = 0.006). The 1-, 3-, and 5-year survival rates were 87, 46, and 31% for AT; 79, 39, and 24% for OB. Subgroup analysis revealed an associated survival advantage for AT in T3/T4 tumors (HR = 0.72; 95% CI 0.59–0.89), node positive disease (HR 0.70; 95% CI 0.56–0.87), and positive margins (HR 0.58; 95% CI 0.42–0.81). Conclusion: AT is associated with improved OS in resected dCCA, especially in T3/T4 tumors, node positive disease, and positive margins.

AB - Background: Data on the efficacy of adjuvant therapy (AT) in distal cholangiocarcinoma (dCCA) is limited. This study aimed to determine the role of AT in resected dCCA and identify subgroups that benefit from AT. Methods: We conducted a retrospective review of surgically resected dCCA in the NCDB from 2004 to 2013. Patients who received AT or observation (OB) were matched by propensity score. Log-rank test was used to compare OS. Results: Of 1782 patients with resected dCCA, 840 (47%) were in the OB group and 942 (53%) in the AT group. AT was younger (64.0 vs. 68.7 years, p < 0.001), had less comorbidities (Charlson Deyo score 0) (74.6 vs. 68.0%, p < 0.001), and more likely to have private insurance (p < 0.001). AT was more likely to present with T3/T4 stage (72 vs. 57%, p < 0.001), N1/N2 disease (58 vs. 37%, p < 0.001), and positive surgical margins (26 vs. 16%, p < 0.001). After 1:1 propensity score matching, 500 OB and 500 AT patients were compared. AT was associated with better OS (HR 0.79; 95% CI 0.67–0.93). Median OS was 31 and 25 months for the AT and OB (p = 0.006). The 1-, 3-, and 5-year survival rates were 87, 46, and 31% for AT; 79, 39, and 24% for OB. Subgroup analysis revealed an associated survival advantage for AT in T3/T4 tumors (HR = 0.72; 95% CI 0.59–0.89), node positive disease (HR 0.70; 95% CI 0.56–0.87), and positive margins (HR 0.58; 95% CI 0.42–0.81). Conclusion: AT is associated with improved OS in resected dCCA, especially in T3/T4 tumors, node positive disease, and positive margins.

KW - Adjuvant therapy

KW - Distal cholangiocarcinoma

KW - Extrahepatic

KW - Propensity score

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U2 - 10.1007/s11605-018-3875-x

DO - 10.1007/s11605-018-3875-x

M3 - Article

C2 - 30030718

AN - SCOPUS:85050358655

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

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