In a cohort study reported in JAMA Surgery, Franssen et al found little difference in median overall survival with hepatic arterial infusion pump (HAIP) floxuridine chemotherapy vs resection in patients with multifocal intrahepatic cholangiocarcinoma.
The study population consisted of 141 consecutive patients who received HAIP floxuridine chemotherapy for unresectable disease between January 2001 and December 2018 at a single U.S. institution, and 178 consecutive patients undergoing curative-intent resection at 12 centers in the United States, Asia, Australia, and Europe between January 1990 and December 2017. Resectable metastatic disease to regional lymph nodes and previous systemic therapy were permitted. Patients with distant metastatic disease, those who underwent resection before starting HAIP floxuridine chemotherapy, and those who received a liver transplant were excluded. The primary outcome measure was overall survival.
This cohort study found that patients with multifocal intrahepatic cholangiocarcinoma had similar overall survival after HAIP floxuridine chemotherapy vs resection. Resection of multifocal intrahepatic cholangiocarcinoma needs to be considered carefully given the complication rate of major liver resection; HAIP floxuridine chemotherapy may be an effective alternative option.— Franssen et al
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The HAIP group had more patients with bilobar disease (88.0% vs 34.3%), larger tumors (median = 8.4 vs 7.0 cm), and more patients with at least four lesions (66.7% vs 24.2%).
Median postoperative length of hospital stay was 6 days vs 12 days. Complications of Clavien-Dindo ≥ grade 3A occurred in 6.4% vs 25.3% of patients (P = .04).
Postoperative mortality after 30 days was 0.8% vs 6.2% (P = .01). Postoperative mortality after 90 days was 5.0% vs 7.9% (P = .37).
Median overall survival was 20.3 months vs 18.9 months (P = .32) among all patients, 29.5 months vs 20.4 months among patients with two or three lesions (P = .46), and 18.0 months vs 15.6 months among those with four or more lesions (P = .86). Overall survival at 5 years was 12.5% vs 20.7% among all patients, 23.7% vs 25.7% among patients with two or three lesions, and 5.0% vs 6.8% among those with four or more lesions.
In multivariate analysis adjusted for tumor diameter, number of tumors, and lymph node metastases, the overall survival hazard ratio for HAIP vs resection was 0.75 (95% confidence interval = 0.55-1.03, P = .07).
The investigators concluded, “This cohort study found that patients with multifocal intrahepatic cholangiocarcinoma had similar overall survival after HAIP floxuridine chemotherapy vs resection. Resection of multifocal intrahepatic cholangiocarcinoma needs to be considered carefully given the complication rate of major liver resection; HAIP floxuridine chemotherapy may be an effective alternative option.”
Bas Groot Koerkamp, MD, PhD, of the Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, is the corresponding author for the JAMA Surgery article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
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