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Войти в исследования Annals of surgical oncology · 2026
Neoadjuvant Therapy as a Selection Strategy for Curative Resection in High-Risk Intrahepatic Cholangiocarcinoma.
СтатьяНазвание и аннотация: Перевод в очереди
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Dong Yawen, Lewis Kever A, Pereyra David, Li Zhihao, Podrascanin Vanja, Gist Galen C, Santol Jonas, Ammann Markus, Kankeu Fonkoua Lionel A, Graham Rondell P, Conboy Caitlin B, Tran Nguyen H, Warner Susanne G, Vauthey Jean-Nicolas, Newhook Timothy E, Cao Hop S Tran, Smoot Rory L, Starlinger Patrick
Аннотация
BACKGROUND: High-risk features (e.g., vascular invasion, lymph node involvement, multifocality, elevated carbohydrate antigen 19-9 [CA19-9], tumor size >5 cm) in intrahepatic cholangiocarcinoma (iCCA) are associated with poor prognosis, leading to increased use of neoadjuvant therapy (NAT).
METHODS: Patients (n = 425) treated in 2000-2024 at Mayo Clinic Rochester were categorized into four groups: (1) high-risk iCCA with NAT (chemotherapy- or chemoimmunotherapy-based regimens) followed by surgery, (2) high-risk iCCA with upfront resection, (3) low-risk iCCA with upfront resection, and (4) high-risk iCCA receiving NAT without surgery ("dropouts"). Outcomes included overall (OS) and recurrence-free survival (RFS). An external cohort of 203 iCCA patients from MD Anderson Cancer Center also was analyzed using identical criteria.
RESULTS: Of 425 patients, 342 (80.5%) were at high risk and 83 (19.5%) were at low risk (all upfront resection). Among the high-risk patients, 172 (50.3%) received NAT and 96 (55.8%) underwent upfront resection, whereas 76 (44.2%) dropped out. The NAT regimens included doublet gemcitabine-cisplatin (GC, n = 56) and triplet chemo(immuno)therapy with gemcitabine-cisplatin-nab-paclitaxel (GAP, n = 30) or gemcitabine-cisplatin-durvalumab (GCD, n = 10). The NAT patients who proceeded to resection showed significantly longer OS than those who had upfront resection (68.6 vs. 34.9 months; p = 0.007), with no significant difference from low-risk patients (106.2 months, p = 0.132). Intensified regimens (GAP/GCD) yielded superior OS, whereas RFS did not significantly differ across groups. Comparable survival trends were observed in the external cohort.
CONCLUSION: Neoadjuvant therapy followed by curative-intent resection was associated with improved OS, reflecting selection of systemic therapy-responsive high-risk patients with more favorable tumor biology, achieving outcomes similar to those of low-risk groups. Conversely, 45% failed to proceed to surgery due to progression or clinical deterioration, experiencing OS comparable with palliative care.
METHODS: Patients (n = 425) treated in 2000-2024 at Mayo Clinic Rochester were categorized into four groups: (1) high-risk iCCA with NAT (chemotherapy- or chemoimmunotherapy-based regimens) followed by surgery, (2) high-risk iCCA with upfront resection, (3) low-risk iCCA with upfront resection, and (4) high-risk iCCA receiving NAT without surgery ("dropouts"). Outcomes included overall (OS) and recurrence-free survival (RFS). An external cohort of 203 iCCA patients from MD Anderson Cancer Center also was analyzed using identical criteria.
RESULTS: Of 425 patients, 342 (80.5%) were at high risk and 83 (19.5%) were at low risk (all upfront resection). Among the high-risk patients, 172 (50.3%) received NAT and 96 (55.8%) underwent upfront resection, whereas 76 (44.2%) dropped out. The NAT regimens included doublet gemcitabine-cisplatin (GC, n = 56) and triplet chemo(immuno)therapy with gemcitabine-cisplatin-nab-paclitaxel (GAP, n = 30) or gemcitabine-cisplatin-durvalumab (GCD, n = 10). The NAT patients who proceeded to resection showed significantly longer OS than those who had upfront resection (68.6 vs. 34.9 months; p = 0.007), with no significant difference from low-risk patients (106.2 months, p = 0.132). Intensified regimens (GAP/GCD) yielded superior OS, whereas RFS did not significantly differ across groups. Comparable survival trends were observed in the external cohort.
CONCLUSION: Neoadjuvant therapy followed by curative-intent resection was associated with improved OS, reflecting selection of systemic therapy-responsive high-risk patients with more favorable tumor biology, achieving outcomes similar to those of low-risk groups. Conversely, 45% failed to proceed to surgery due to progression or clinical deterioration, experiencing OS comparable with palliative care.