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Real-world experience of postoperative adjuvant chemoimmunotherapy in patients with perihilar cholangiocarcinoma at high risk of recurrence

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Abstract

Background

This study aimed to assess whether postoperative adjuvant chemoimmunotherapy could lead to better clinical outcomes for high-risk patients with perihilar cholangiocarcinoma (pCCA).

Methods

In the cohort study, we retrospectively reviewed patients who received surgical resection for pCCA with curative intent from January 2018 to December 2021 at the Sun Yat-sen Memorial Hospital.

The patients at high risk for relapse were further analyzed. Among them, 20 patients received adjuvant chemoimmunotherapy, 28 patients received adjuvant chemotherapy, and 33 patients received surgery alone. The oncological outcomes and drug-associated adverse events were evaluated.

Results

The 2-year overall survival (OS) rates in patients treated with adjuvant chemoimmunotherapy, adjuvant chemotherapy, and surgery alone were 80.0%, 49.4% and 22.6%, respectively. Univariable and multivariable Cox analyses showed that the treatment regimen and TNM stage were associated with adverse OS. Adjuvant chemoimmunotherapy led to an increase in OS compared with adjuvant chemotherapy [hazard ratio (HR) = 3.253; 95% confidence interval (CI) 1.072–9.870; P = 0.037] or surgery alone (HR = 7.560; 95% CI 2.508–22.785; P < 0.001). The median recurrence-free survival was 22.0 months for the adjuvant chemoimmunotherapy group, 17.0 months for the adjuvant chemotherapy group, and 13.2 months for the surgery alone group (P = 0.177); these differences were not significant. The chemoimmunotherapy group was associated with more frequent hematological side effects than the chemotherapy group, but the difference was not statistically significant.

Conclusion

Postoperative adjuvant chemoimmunotherapy for resected pCCA patients showed improved OS compared with adjuvant chemotherapy or surgery alone, and further prospectively randomized controlled trials are necessary to validate these results.

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Funding

This work was supported by the Special Research Foundation of the National Nature Science Foundation of China (82273476, 81972262, 81972255, 82173195); Grant [2013] 163 from Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology; Grant KLB09001 from the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes; Grant from Guangdong Science and Technology Department (2015B050501004, 2017B030314026); Sun Yat-sen University Clinical Research 5010 Program (2018008).

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Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China

    Qin-qin Liu, Xiang-de Shi, Qi-bin Tang, Hao-ming Lin, Xian-huan Yu, Rui Zhang & Chao Liu

  2. Clinical Research Design Division, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China

    Yan-fang Ye

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  1. Qin-qin Liu
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Contributions

QQL, RZ, and CL designed the research. QQL, JXM, JLW, SLC, and YH wrote the protocol. QQL and XDS collected the data. QQL, XDS, and YFY analyzed the data. QQL, XDS,and YFY wrote the manuscript. QBT, HML, XHY, RZ, and CL revised the manuscript. All authors have reviewed and approved the manuscript

Corresponding authors

Correspondence to Rui Zhang or Chao Liu.

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Liu, Qq., Shi, Xd., Ye, Yf. et al. Real-world experience of postoperative adjuvant chemoimmunotherapy in patients with perihilar cholangiocarcinoma at high risk of recurrence. Cancer Immunol Immunother 72, 1753–1761 (2023). https://doi.org/10.1007/s00262-022-03362-7

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