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Systemic chemotherapy plus transarterial chemoembolization versus systemic chemotherapy alone for unresectable intrahepatic cholangiocarcinoma: a multicenter retrospective cohort study

  • Radiotherapy
  • Published:
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A Correction to this article was published on 13 May 2024

This article has been updated

Abstract

Purpose

Systemic chemotherapy (SYS) is the first-line treatment of unresectable intrahepatic cholangiocarcinoma (ICC). However, the survival benefit of SYS is still limited. This study compared the efficacy and safety of patients with unresectable ICC treated with transarterial chemoembolization (TACE) plus SYS to SYS alone.

Material and methods

The multicenter retrospective cohort study included patients aged ≥ 18 years old with pathologically diagnosed ICC. Patients with unmeasurable lesions, not receiving SYS treatment, Child–Pugh grade C, Eastern Cooperative Oncology Group performance status score of 3 or higher, prior liver resection, incomplete medical information, or discontinuation of the first SYS treatment were excluded. Data collection was mainly from the hospital system, and the survival outcome of patients was obtained through follow-up. Overall survival (OS) was estimated using the Kaplan–Meier method and compared using the log-rank test. Propensity score matching at a 1:1 ratio using the nearest neighbor matching algorithm was performed to reduce selection bias between the TACE plus SYS and SYS alone groups. The Cox proportional hazards model was used to identify prognostic factors associated with OS and to estimate their hazard ratios. Modified Response Evaluation Criteria in Solid Tumors criteria were utilized to evaluate the response of tumors to therapy.

Results

Between June 2016 and February 2023, 118 unresectable ICC patients from three hospitals were included in this study. Of them, 37 were in the TACE plus SYS group and 81 were in the SYS alone group. The median OS in the combination group was 11.3 months, longer than the 6.4 months in the SYS alone group (P = 0.011). A greater objective response rate (ORR) and disease control rate (DCR) were observed in the combination group than in the SYS alone group (ORR, 48.65 vs. 6.17%, P < 0.001; DCR, 89.19 vs. 62.96%, P = 0.004). There were 16 patients in each group after matching, and the matched results remained consistent regarding OS and tumor response. Adverse events (AEs) were similar in the two groups after matching.

Conclusion

Compared to SYS alone, the combination treatment of TACE plus SYS was more effective than SYS alone in improving OS, ORR, and DCR without any significant increase in AEs. TACE plus SYS may be a viable treatment option for patients with unresectable ICC.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author upon reasonable request.

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Funding

This work was supported by grants from the National Natural Science Foundation of China-Youth Science Fund (Grant number 81901713) and Health Commission of Hubei Province (Grant number WJ2023M012). Authors Ketao Mu and Hualing Li have received research support. The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Nan Jiang and Ze Zhang have contributed equally.

Authors and Affiliations

  1. Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China

    Nan Jiang, Yonghong Hao, Wenhua Yang, Hualing Li, Anhui Xu & Ketao Mu

  2. School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Nan Jiang, Ze Zhang & Xiaoxv Yin

  3. Department of Radiology, PLA Central Military Command General Hospital, Wuhan, 430070, China

    Huaiming Qiu

  4. Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430079, China

    Weipeng Yan

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Contributions

KM and AX contributed to the study conception and design. Material preparation, data collection, analysis, and interpretation were performed by NJ, ZZ, XY, HQ, WY, YH, WY, and HL. The first draft of the manuscript was written by NJ and ZZ. KM, AX, XY, HQ, WY, YH, WY, and HL critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Anhui Xu or Ketao Mu.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This retrospective cohort study was performed in accordance with the principles of the Declaration of Helsinki. The study was approved by the Ethical Review Committee of Tongji Hospital, Huazhong University of Science and Technology, and informed consent from patients to study participation was waived due to its retrospective nature.

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Jiang, N., Zhang, Z., Yin, X. et al. Systemic chemotherapy plus transarterial chemoembolization versus systemic chemotherapy alone for unresectable intrahepatic cholangiocarcinoma: a multicenter retrospective cohort study. Radiol med 129, 631–642 (2024). https://doi.org/10.1007/s11547-024-01781-3

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