Work

Benefiting Subgroup From Adjuvant Chemotherapy in Intrahepatic Cholangiocarcinoma: A Propensity Score‐Matched Study

Year: 2026

Type: article

Abstract: The survival benefit of adjuvant chemotherapy (ACT) following resection of intrahepatic cholangiocarcinoma (iCCA) remains controversial; moreover, the patient group that could benefit most from this approach remains undetermined. We conducted a retrospective cohort study of 423 patients (median age 65 years; 52.2% male; 297 patients who received ACT) who underwent curative intent resection of iCCA between 2021 and 2024. To minimize selection bias, propensity score matching (PSM) at a 2:1 ratio was performed. Overall survival (OS) was the primary end point. Survival analyses were conducted using Kaplan-Meier and Cox regression methods. In the PSM-matched cohort, ACT significantly improved OS compared to observation alone (hazard ratio [HR] = 0.52, 95% confidence interval [CI]: 0.32-0.82, p = 0.005). Subgroup analyses revealed marked heterogeneity in treatment effect. The most remarkable finding was a strong interaction between treatment and histological subtype (p for interaction = 0.041). Patients with small-duct type iCCA derived a substantial survival benefit from ACT (HR = 0.33, 95% CI: 0.17-0.63, p = 0.001). In contrast, patients with large-duct type iCCA did not show a significant OS benefit (HR = 0.89, 95% CI: 0.45-1.76, p = 0.737). In conclusion, postoperative ACT was associated with improved OS after resection of iCCA. Exploratory interaction analyses suggested that the magnitude of this association may differ according to histological subtype, with a more pronounced survival benefit observed in patients with small-duct type iCCA. These findings should be considered hypothesis-generating and require confirmation in independent prospective cohorts before histological subtype can be incorporated into treatment-selection strategies.

Source: Cancer Medicine

DOI: 10.1002/cam4.72476