In:
Liver Cancer, S. Karger AG, Vol. 11, No. 5 ( 2022), p. 460-473
Abstract:
〈 b 〉 〈 i 〉 Backgrounds and Aims: 〈 /i 〉 〈 /b 〉 Even if no systemic treatment is currently validated for unresectable hepatocellular-cholangiocarcinoma (cHCC-CCA), tyrosine kinase inhibitors (TKIs) and platinum-based chemotherapy are frequently used in clinical practice. Our study aims to describe the effectiveness of first-line systemic treatments in patients with cHCC-CCA. 〈 b 〉 〈 i 〉 Patients and Methods: 〈 /i 〉 〈 /b 〉 Patients with histological diagnosis of unresectable or metastatic cHCC-CCA confirmed by a centralized review (WHO classification 2019) and who received systemic treatment from 2009 to 2020 were included retrospectively in 11 centers. The outcomes of patients with cHCC-CCA were compared with patients with hepatocellular carcinoma (HCC) treated by sorafenib ( 〈 i 〉 n 〈 /i 〉 = 117) and with intrahepatic cholangiocarcinoma (iCCA, 〈 i 〉 n 〈 /i 〉 = 94) treated mainly by platinum-based chemotherapy using a frailty Cox model. The efficacy of TKIs and platinum-based chemotherapies in patients with cHCC-CCA was assessed using a doubly robust estimator. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 83 patients with cHCC-CCA were included and were predominantly male (72%) with underlying cirrhosis (55%). 67% of patients had extrahepatic metastases and 31% macrovascular tumor invasion. cHCC-CCAs were more often developed on cirrhosis (55.4%) than iCCA (26.6%) but less frequently than HCC (80.2%) ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Both HCC (36.8% and cHCC-CCA (66.2%) had less frequent extrahepatic metastases than iCCA (81%) ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Unadjusted overall survival (OS) was better in iCCA (13 months) compared to cHCC-CCA (12 months) and HCC (11 months) ( 〈 i 〉 p 〈 /i 〉 = 0.130). In multivariable analysis, after adjustment by a Cox frailty model, patients with cHCC-CCA had the same survival as HCC and iCCA (HR = 0.67, 95% CI: 0.37–1.22, 〈 i 〉 p 〈 /i 〉 = 0.189 and HR = 0.66, 95% CI: 0.43–1.02, 〈 i 〉 p 〈 /i 〉 = 0.064, respectively). ALBI score (HR = 2.15; 95% CI: 1.23–3.76; 〈 i 〉 p 〈 /i 〉 = 0.009), ascites (HR = 3.45, 95% CI: 1.31–9.03, 〈 i 〉 p 〈 /i 〉 = 0.013), and tobacco use (HR = 2.29, 95% CI: 1.08–4.87, 〈 i 〉 p 〈 /i 〉 = 0.032) were independently associated with OS in patients with cHCC-CCA. Among patients with cHCC-CCA, 25 patients treated with TKI were compared with 54 patients who received platinum-based chemotherapies. Patients treated with TKI had a median OS of 8.3 months compared to 11.9 months for patients treated with platinum-based chemotherapy ( 〈 i 〉 p 〈 /i 〉 = 0.86). After a robust doubly adjustment on tumor number and size, vascular invasion, ALBI, MELD, and cirrhosis, the type of treatment did not impact OS (HR = 0.92, 95% CI: 0.27–3.15, 〈 i 〉 p 〈 /i 〉 = 0.88) or progression-free survival (HR = 1.24, 95% CI: 0.44–3.49, 〈 i 〉 p 〈 /i 〉 = 0.67). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 First-line systemic treatments with TKIs or platinum-based chemotherapies have similar efficacy in patients with unresectable/metastatic cHCC-CCA. The ALBI score predicts OS.
Type of Medium:
Online Resource
ISSN:
2235-1795
,
1664-5553
Language:
English
Publisher:
S. Karger AG
Publication Date:
2022
detail.hit.zdb_id:
2666925-0
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