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Intrahepatic cholangiocarcinoma: Does liver directed therapy provide effective local disease control?
Chad H VanSant-Webb1, Karina C Geranios2, G Weldon Gilcrease3
1Department of Medicine, University of Utah, Salt Lake City, UT, 84112, USA.
Introduction:
Surgical resection is the only treatment known to provide durable disease-free survival in patients with intrahepatic cholangiocarcinoma (iCCA). Many with iCCA are not candidates for resection because of tumor size, location, or comorbid disease. The efficacy of newer forms of liver directed therapy (LDT) relative to resection has not been defined.
Methods:
We compare outcomes for patients undergoing LDT for clinical stage I to IVa iCCA in our healthcare system between 2010 and 2024 to those undergoing resection. Multivariable regression (MVR), Cox modeling and Kaplan-Meier Analysis were used to identify factors associated with resection, overall (OS) and disease-specific (DSS) survival.
Results:
77 (48.7 %) patients underwent treatment for localized iCCA; 39 (50.6 %) underwent LDT, 38 (49.4 %) resection. On MVR, patients of advanced age were less likely to undergo resection (AOR 0.92, p < 0.01). On Cox modeling, compromised performance status (ECOG ≥1: HR 2.59, p = 0.011) was associated with decreased OS; systemic therapy (HR 0.27, p < 0.01) and resection (HR 0.71, p < 0.01) were associated with increased OS. On Kaplan-Meyer analysis, there was no significant difference in OS or DSS between treatment cohorts (p > 0.05).
Conclusion:
LDT offers local disease control comparable to resection and may be considered definitive local treatment in appropriately selected patients with iCCA.
