Comparison of adjuvant treatment for intrahepatic cholangiocarcinoma.

Abstract

e16278 Background: Adjuvant therapy is beneficial to improve the prognosis of intrahepatic cholangiocarcinoma (ICC) patients. Currently, there is a significant body of research on adjuvant therapy for patients with biliary duct cancer. However, studies focusing specifically on patients with intrahepatic cholangiocarcinoma remain in the early stages of development. This study aimed to investigate the necessity of postoperative adjuvant chemotherapy and the efficacy and safety of different regimes among patients with ICC, with a particular focus on the role of immunotherapy in the treatment approach. Methods: The data of 221 patients diagnosed with intrahepatic cholangiocarcinoma (ICC), who underwent radical resection between January 2011 and October 2023 at the Tianjin Medical University Cancer Institute and Hospital, were retrospectively analyzed. Kaplan–Meier survival curves were used to compare disease-free survival (DFS) and overall survival (OS) between three groups: those who received two different adjuvant chemotherapy regimens (gemcitabine plus oxaliplatin [GEMOX] and capecitabine monotherapy) and those who underwent surgical treatment alone (non-AC group). The analysis further examined the DFS, OS, and safety profiles of the patients receiving the two chemotherapy regimens - GEMOX and capecitabine. Additionally, the efficacy of capecitabine alone was compared with that of capecitabine combined with immune checkpoint inhibitor (ICI) therapy. Results: The study demonstrated that both the capecitabine group (DFS: P < 0.001; OS: P = 0.002) and the GEMOX group (DFS: P = 0.0076; OS: P = 0.003) exhibited significantly longer DFS and OS compared to the non-AC group. However, no statistically significant differences were observed in OS (P = 0.24) or DFS (P = 0.22) when comparing the GEMOX and capecitabine groups. Notably, the incidence of myelosuppression (Grade 3-4) was significantly higher in the GEMOX group than in the capecitabine group (P = 0.048). Additionally, the combination of capecitabine and immunotherapy did not show any improvement in OS (P = 0.97) or DFS (P = 0.52) compared to capecitabine monotherapy. Conclusions: Adjuvant chemotherapy has been shown to significantly improve patient prognosis. While no substantial difference in outcomes was observed between patients treated with capecitabine and those receiving GEMOX, capecitabine exhibited a more favorable safety profile. Furthermore, combining capecitabine with immunotherapy did not result in improved outcomes compared to capecitabine monotherapy.