Related Experiment Video
Updated: Jan 14, 2026
Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb
Published on: January 17, 2025
Comparative efficacy of neoadjuvant chemotherapy plus surgical resection vs upfront surgery for potentially
Abdulaziz Elemosho1, Odysseas P Chatzipanagiotou1, Meher Angez1
1Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States.
Background:
Intrahepatic cholangiocarcinoma (ICC) is a rare but aggressive malignancy with poor long-term survival and high recurrence. Although upfront surgery has been historically regarded as the standard of care, neoadjuvant chemotherapy (NAT) has been proposed as a potential preferred treatment strategy. We sought to predict long-term outcomes of patients with ICC treated with upfront resection versus NAT followed by surgery.
Methods:
A population survival kinetics analysis was performed to compare NAT followed by resection with upfront surgery using reconstructed individual patient data (IPD) from Kaplan-Meier curves across trials and studies published between 1990 and 2025. Curves were digitized using the widely validated Guyot method. 1- and 2-phase survival models were applied to estimate median survival, recurrence risk, and proportions of patients biologically "at risk."
Results:
Patients in the NAT-resection arm had longer median overall survival (OS) (52.9 vs 37.0 months) and delayed recurrence (34.6 vs 24.4 months) compared with individuals in the upfront surgery arm. The proportion of patients "at risk" of death or recurrence was lower in the NAT-resection arm (46.4% vs 75.3% for death; 57.7% vs 65.7% for recurrence). Among individuals at risk, time to relapse was extended in the NAT-resection arm (death, 29.8 vs 24.2 months; recurrence, 16.5 vs 10.7 months). At 5 years, OS was higher with NAT-resection (45.7% vs 32.5%), and the proportion of at-risk patients considered cured was nearly double (82.5% vs 64.9%). On pooled hazard risk estimation, upfront surgery was associated with an increased risk of recurrence (hazard ratio [HR], 1.36; P <.001) and death (HR, 1.16; P =.012).
Conclusion:
NAT followed by resection for resectable ICC was associated with prolonged survival, reduced recurrence, and a higher probability of long-term cure. These findings challenge current guidelines and support incorporating NAT into the standard treatment algorithm, particularly for patients at high risk of early relapse. Randomized trials are warranted to validate these findings.
