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e16211 Background: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy after hepatocellular carcinoma. Anecdotal evidence shows that chemotherapy and radiotherapy after surgical resection confer better survival outcomes in patients with advanced disease. This study aims to demonstrate outcomes of different therapeutic options in patients with stage 4 ICC. Methods: We queried the National Cancer Database from 2004 to 2020 to identify patients with stage 4 ICC. The study compared median overall survival (mOS) using Kaplan-Meier methodology and pair-wise log-rank test among different therapeutic groups, including surgery (Sx) alone, chemotherapy (CT) alone, radiotherapy (RT) alone, surgery + chemotherapy (Sx+CT), surgery + chemoradiation (Sx+CRT), and chemoradiation (CRT). The results of the study were reported in concordance with STROBE guidelines. Results: Among 13,735 patients with stage 4 ICC, the median age was 64 years (range: 17-90+ years), 51.0% were male, 83.6% were White, 9.1% Black and 4.0 % Asian. 342 (2.5%) underwent Sx, 10061 (73.3%) CT alone, 427 (3.1%) underwent RT alone, 744 (5.4%) Sx+CT, 314 (2.3%) Sx+CRT, and 1847 (13.5%) underwent CRT. Patients who underwent Sx+CRT had better mOS (23.8 months, 95% CI 20.5-24.1) than all other modalities, including Sx (11.1 months, 95% CI 8.2-13.4), CT (8.6 months, 95% CI 8.4-8.9), RT (4.7 months, 95% CI 3.8-5.2), Sx+CT (21.9 months, 95% CI 20.0-24.1) and CRT (11.7 months, 95% CI 11.1-12.3) p < 0.01. Conclusions: Unlike other gastrointestinal malignancies, multimodal therapy i.e., chemoradiation after surgical resection of primary tumor improves survival in advanced ICC. However, prospective studies affirming these findings are warranted.Table: see text
Jayram et al. (Sat,) studied this question.