Resection and chemotherapy is the optimal treatment approach for patients with clinically node positive intrahepatic cholangiocarcinoma

Sean P. Martin, Justin Drake, Michael M. Wach, Samantha M. Ruff, Laurence P. Diggs, Jim Wan, Meghan L. Good, Dana A. Dominguez, Reed I. Ayabe, Evan Glazer, Paxton V. Dickson, Jeremy L. Davis, Jeremiah Deneve, Jonathan M. Hernandez

Research output: Contribution to journalArticle

Abstract

Background: Clinically lymph node positive (cLNP) intrahepatic cholangiocarcinoma (ICC) carries a poor prognosis, without clear management guidelines for the practicing clinician. We sought to evaluate current practice patterns for cLNP ICC, including associations with survival. Methods: The National Cancer Database was queried for patients with cLNP ICC, without extrahepatic metastases. Results: We identified 1023 patients with cLNP ICC, 77%% (n = 784) of whom received chemotherapy alone. Resection was undertaken in 23% (n = 239) of patients and was most commonly utilized in combination with chemotherapy (n = 150). Median survival for all patients was 13.6 months. Patients undergoing resection in combination with chemotherapy were associated with an improved survival (22.5 months) as compared to those patients receiving chemotherapy alone (11.9 months) or resection alone (12.4 months) (p < 0.01). Finally, we compared the survival of patients with cLNP ICC with that of patients with pathologically proved lymph node positive (pLNP) ICC, all of whom were treated with resection with chemotherapy, and found no difference in survival (22.5 months–19.3 months, p = 0.99, respectively). Conclusions: While the decision to pursue resection for ICC is multifactorial and patient specific, the presence of clinically positive LNs should not represent a contraindication.

Original languageEnglish (US)
JournalHPB
DOIs
StatePublished - Jan 1 2019

Fingerprint

Cholangiocarcinoma
Drug Therapy
Lymph Nodes
Survival
Therapeutics
Combination Drug Therapy
Databases
Guidelines
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Resection and chemotherapy is the optimal treatment approach for patients with clinically node positive intrahepatic cholangiocarcinoma. / Martin, Sean P.; Drake, Justin; Wach, Michael M.; Ruff, Samantha M.; Diggs, Laurence P.; Wan, Jim; Good, Meghan L.; Dominguez, Dana A.; Ayabe, Reed I.; Glazer, Evan; Dickson, Paxton V.; Davis, Jeremy L.; Deneve, Jeremiah; Hernandez, Jonathan M.

In: HPB, 01.01.2019.

Research output: Contribution to journalArticle

Martin, SP, Drake, J, Wach, MM, Ruff, SM, Diggs, LP, Wan, J, Good, ML, Dominguez, DA, Ayabe, RI, Glazer, E, Dickson, PV, Davis, JL, Deneve, J & Hernandez, JM 2019, 'Resection and chemotherapy is the optimal treatment approach for patients with clinically node positive intrahepatic cholangiocarcinoma', HPB. https://doi.org/10.1016/j.hpb.2019.06.007
Martin, Sean P. ; Drake, Justin ; Wach, Michael M. ; Ruff, Samantha M. ; Diggs, Laurence P. ; Wan, Jim ; Good, Meghan L. ; Dominguez, Dana A. ; Ayabe, Reed I. ; Glazer, Evan ; Dickson, Paxton V. ; Davis, Jeremy L. ; Deneve, Jeremiah ; Hernandez, Jonathan M. / Resection and chemotherapy is the optimal treatment approach for patients with clinically node positive intrahepatic cholangiocarcinoma. In: HPB. 2019.
@article{c810ecde8a1543f2ad38677f4f1fd937,
title = "Resection and chemotherapy is the optimal treatment approach for patients with clinically node positive intrahepatic cholangiocarcinoma",
abstract = "Background: Clinically lymph node positive (cLNP) intrahepatic cholangiocarcinoma (ICC) carries a poor prognosis, without clear management guidelines for the practicing clinician. We sought to evaluate current practice patterns for cLNP ICC, including associations with survival. Methods: The National Cancer Database was queried for patients with cLNP ICC, without extrahepatic metastases. Results: We identified 1023 patients with cLNP ICC, 77{\%}{\%} (n = 784) of whom received chemotherapy alone. Resection was undertaken in 23{\%} (n = 239) of patients and was most commonly utilized in combination with chemotherapy (n = 150). Median survival for all patients was 13.6 months. Patients undergoing resection in combination with chemotherapy were associated with an improved survival (22.5 months) as compared to those patients receiving chemotherapy alone (11.9 months) or resection alone (12.4 months) (p < 0.01). Finally, we compared the survival of patients with cLNP ICC with that of patients with pathologically proved lymph node positive (pLNP) ICC, all of whom were treated with resection with chemotherapy, and found no difference in survival (22.5 months–19.3 months, p = 0.99, respectively). Conclusions: While the decision to pursue resection for ICC is multifactorial and patient specific, the presence of clinically positive LNs should not represent a contraindication.",
author = "Martin, {Sean P.} and Justin Drake and Wach, {Michael M.} and Ruff, {Samantha M.} and Diggs, {Laurence P.} and Jim Wan and Good, {Meghan L.} and Dominguez, {Dana A.} and Ayabe, {Reed I.} and Evan Glazer and Dickson, {Paxton V.} and Davis, {Jeremy L.} and Jeremiah Deneve and Hernandez, {Jonathan M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.hpb.2019.06.007",
language = "English (US)",
journal = "HPB",
issn = "1365-182X",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Resection and chemotherapy is the optimal treatment approach for patients with clinically node positive intrahepatic cholangiocarcinoma

AU - Martin, Sean P.

AU - Drake, Justin

AU - Wach, Michael M.

AU - Ruff, Samantha M.

AU - Diggs, Laurence P.

AU - Wan, Jim

AU - Good, Meghan L.

AU - Dominguez, Dana A.

AU - Ayabe, Reed I.

AU - Glazer, Evan

AU - Dickson, Paxton V.

AU - Davis, Jeremy L.

AU - Deneve, Jeremiah

AU - Hernandez, Jonathan M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Clinically lymph node positive (cLNP) intrahepatic cholangiocarcinoma (ICC) carries a poor prognosis, without clear management guidelines for the practicing clinician. We sought to evaluate current practice patterns for cLNP ICC, including associations with survival. Methods: The National Cancer Database was queried for patients with cLNP ICC, without extrahepatic metastases. Results: We identified 1023 patients with cLNP ICC, 77%% (n = 784) of whom received chemotherapy alone. Resection was undertaken in 23% (n = 239) of patients and was most commonly utilized in combination with chemotherapy (n = 150). Median survival for all patients was 13.6 months. Patients undergoing resection in combination with chemotherapy were associated with an improved survival (22.5 months) as compared to those patients receiving chemotherapy alone (11.9 months) or resection alone (12.4 months) (p < 0.01). Finally, we compared the survival of patients with cLNP ICC with that of patients with pathologically proved lymph node positive (pLNP) ICC, all of whom were treated with resection with chemotherapy, and found no difference in survival (22.5 months–19.3 months, p = 0.99, respectively). Conclusions: While the decision to pursue resection for ICC is multifactorial and patient specific, the presence of clinically positive LNs should not represent a contraindication.

AB - Background: Clinically lymph node positive (cLNP) intrahepatic cholangiocarcinoma (ICC) carries a poor prognosis, without clear management guidelines for the practicing clinician. We sought to evaluate current practice patterns for cLNP ICC, including associations with survival. Methods: The National Cancer Database was queried for patients with cLNP ICC, without extrahepatic metastases. Results: We identified 1023 patients with cLNP ICC, 77%% (n = 784) of whom received chemotherapy alone. Resection was undertaken in 23% (n = 239) of patients and was most commonly utilized in combination with chemotherapy (n = 150). Median survival for all patients was 13.6 months. Patients undergoing resection in combination with chemotherapy were associated with an improved survival (22.5 months) as compared to those patients receiving chemotherapy alone (11.9 months) or resection alone (12.4 months) (p < 0.01). Finally, we compared the survival of patients with cLNP ICC with that of patients with pathologically proved lymph node positive (pLNP) ICC, all of whom were treated with resection with chemotherapy, and found no difference in survival (22.5 months–19.3 months, p = 0.99, respectively). Conclusions: While the decision to pursue resection for ICC is multifactorial and patient specific, the presence of clinically positive LNs should not represent a contraindication.

UR - http://www.scopus.com/inward/record.url?scp=85068955961&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068955961&partnerID=8YFLogxK

U2 - 10.1016/j.hpb.2019.06.007

DO - 10.1016/j.hpb.2019.06.007

M3 - Article

AN - SCOPUS:85068955961

JO - HPB

JF - HPB

SN - 1365-182X

ER -