353 Background: High rates of recurrence following surgery (S) for intrahepatic cholangiocarcinoma (ICC) have prompted treatment strategies that incorporate chemotherapy (CT). However the benefit of CT remains poorly defined. The present study sought to determine the survival impact of CT for surgically resected ICC. Methods: Patients with non-metastatic ICC that underwent curative intent surgery (R0) were identified from the National Cancer Database (1998-2011) and stratified by receipt of CT. Log rank tests and cox proportional hazards models were used to examine overall survival (OS). Results: A total of 1,729 patients were identified (median age: 66 years, 53% female); 520 (30.1%) received CT. Patients receiving CT were younger (61 vs 66 years, p<0.01), had larger tumors (>5cm: 47 vs 40%, p<0.01), and had a higher frequency of lymph node metastasis (23 vs 12%, p<0.01). However, lymph node evaluation was not conducted in 30% (n=519) of the collective cohort. In the entire series, there was no difference in unadjusted median OS between patients receiving CT compared to S alone (30 vs 32 months, p=0.31). In multivariate models, advanced tumor stage and lymph node status (p<0.05) were associated with shorter OS. When stratified by lymph node status, CT demonstrated a significant improvement in median OS among N1 patients (HR: 0.47, 95%CI: 0.25-0.87; p=0.02). In contrast, patients with N0 disease derived no benefit from CT (HR: 0.95, 95%CI: 0.65-1.39; p=0.80). Conclusions: The use of CT was associated with a survival benefit only for ICC patients with nodal metastasis. Assessment of lymph nodes at the time of surgical resection is critical when attempting to identify a subgroup of patients best suited for CT.
A radiomics approach based on support vector machine using MR images for preoperative lymph node status evaluation in intrahepatic cholangiocarcinoma
