Evaluation of Postoperative Adjuvant Chemotherapy for Intrahepatic Cholangiocarcinoma Patients undergoing R1 and R2 Resections

Surgical resection is the gold standard treatment and is considered the only potential cure for cholangiocarcinoma(CCA). However, most of the patients present at a late stage of disease and positive margins are frequentlyencountered. Therefore, adjuvant therapeutic modalities, such as chemotherapy and/or radiotherapy are neededto improve the survival time of CCA patients. In this study, we analyzed retrospectively the clinical features,overall survival and efficacy with postoperative adjuvant chemotherapy for 171 intrahepatic CCA patients.All those with histologically proved intrahepatic CCA diagnosed during 1998-2002, at Srinagarind Hospital,Faculty of Medicine, Khon Kean University, Thailand, were included in this study. All patients were consideredto have resectable tumors with curative intent, 114 patients received postoperative adjuvant chemotherapywith 5-fluorouracil/mitomycin C, of which only 54 patients were given the full 6 cycle treatment. Mass formingtype CCA was the major type found in our series. The predictive clinicopathological factors which influencedan unfavorable outcome were tumor size >4 cm, multiple masses, mass forming and periductal gross type,histology with poor differentiation, involvement of serosa, vasculature or diaphragm, advanced tumor stageand positive surgical margin. On the other hand, R0 resection, skeletonization of hepatoduodenal ligaments andcomplete postoperative adjuvant chemotherapy were predictive of a favorable outcome. Multivariate analysisCox proportional hazards models revealed that sex, tumor size, serosa involvement, surgical margin status,skeletonization and postoperative adjuvant chemotherapy were independently associated with long term survivalpost-surgery. Regardless of the surgical margin status, patients who received complete postoperative adjuvantchemotherapy had a significant survival advantage.