Comparing Survival of Perihilar Cholangiocarcinoma After R1 Resection Versus Palliative Chemotherapy for Unresected Localized Disease

Abstract

Survival; Perihilar cholangiocarcinoma; Palliative chemotherapy

Supervivència; Colangiocarcinoma perihilar; Quimioteràpia pal·liativa

Supervivencia; Colangiocarcinoma perihiliar; Quimioterapia paliativa

Background Resection of perihilar cholangiocarcinoma (pCCA) is a complex procedure with a high risk of postoperative mortality and early disease recurrence. The objective of this study was to compare patient characteristics and overall survival (OS) between pCCA patients who underwent an R1 resection and patients with localized pCCA who received palliative systemic chemotherapy. Methods Patients with a diagnosis of pCCA between 1997–2021 were identified from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry. pCCA patients who underwent an R1 resection were compared with patients with localized pCCA (i.e., nonmetastatic) who were ineligible for surgical resection and received palliative systemic chemotherapy. The primary outcome was OS. Results Overall, 146 patients in the R1 resection group and 92 patients in the palliative chemotherapy group were included. The palliative chemotherapy group more often underwent biliary drainage (95% vs. 66%, p < 0.001) and had more vascular encasement on imaging (70% vs. 49%, p = 0.012) and CA 19.9 was more frequently >200 IU/L (64 vs. 45%, p = 0.046). Median OS was comparable between both groups (17.1 vs. 16 months, p = 0.06). Overall survival at 5 years after diagnosis was 20.0% with R1 resection and 2.2% with chemotherapy. Type of treatment (i.e., R1 resection or palliative chemotherapy) was not an independent predictor of OS (hazard ratio 0.76, 95% confidence interval 0.55–1.07). Conclusions Palliative systemic chemotherapy should be considered instead of resection in patients with a high risk of both R1 resection and postoperative mortality.

The ENS-CCA Registry is competitively funded by the European Association for the Study of the Liver (EASL; Registry grant awards 2016, 2019 and 2022) and Incyte Biosciences International Sàrl (grant award 2020). Dr Jesus M Banales and Dr Angela Lamarca received funding from the European Union’s Horizon 2020 Research and Innovation Programme [grant number 825510, ESCALON]. Dr Angela Lamarca received funding from Spanish Society of Medical Oncology (SEOM) Fellowship Programme (Return Fellowship).