Abstract 66P
Background
Surgery is the only curative treatment in iCCA. However, median overall survival (OS) after radical surgery is 27-36 months (mos) and up to 70% of patients (pts) recurs. The identification of preoperative prognostic factors is warranted to better define treatment strategy.
Methods
This retrospective study aims at investigating the prognostic impact of preliminary selected preoperative factors in pts with iCCA who underwent curative resection at National Cancer Institute of Milan. The primary endpoint was overall survival (OS) analysed using the Kaplan-Meier method and Cox proportional-hazards models. A prognostic model was developed based on the regression beta-coefficients of the multivariable model.
Results
154 pts were included, with a median follow up of 153 mos. A weighted composite prognostic score was designed according to four preoperative factors: [(CA19.9 ≥ 100 * 0.19) + (presence of multiple or satellite liver nodules * 0.41) + (vascular involvement * 0.18) + (maximum diameter of the tumor ≥5 cm * 0.13)] *100. The study cohort was divided according to the distribution of the derivative score in group A (score = 0), B (score = 1-50) and C (score = >50). Median OS was 60.2, 44.7 and 24.4 mos in group A, B and C, respectively (p=0.009). Multivariable analysis adjusting for other significant variables, namely gender and BMI≥25, revealed an HR for group B vs A of 2.07 (95% CI 1.18-3.60, p=0.01) and C vs A of 2.41 (95% CI 1.35 -4.30, p=0.003). Additionally, the unweighted presence of at least one risk factor was associated with significantly poorer OS [30.6 vs 60.2 mos, HR 1.96 (95% CI 1.21 - 3.16), p=0.006].
Conclusions
There is no standard neoadjuvant therapy for iCCA. However, an effective neoadjuvant strategy in iCCA may reduce the recurrence rate and help excluding from surgery pts at risk for rapid systemic disease progression. In our study, the presence of preliminary selected, preoperative risk factors was associated with poorer survival in resected iCCA pts. If validated, it provides a useful tool to stratify pts according to easily reproducible clinical features that could help to assess the need for a neoadjuvant approach.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Disclosure
M. Niger: Honoraria (self): EMD Sarono. F. Pietrantonio: Honoraria (self), speaker activities and partecipation in advisory boards: Sanofi SA; Honoraria (self), speaker activities and partecipation in advisory boards: Amgen, Inc; Honoraria (self), speaker activities and partecipation in advisory boards: bayer AG; Honoraria (self), speaker activities and partecipation in advisory boards: merck-serono; Honoraria (self), speaker activities and partecipation in advisory boards: Roche; Honoraria (self), speaker activities and partecipation in advisory boards: Servier Laboratories. M. Di Bartolomeo: Honoraria (self), speaker activities and partecipation in advisory boards: amgen; Honoraria (self), speaker activities and partecipation in advisory boards: roche; Honoraria (self), speaker activities and partecipation in advisory boards: Eli Lilly; Honoraria (self), speaker activities and partecipation in advisory boards: Servier Laboratories; Honoraria (self), speaker activities and partecipation in advisory boards: Incyte Corp; Honoraria (self), speaker activities and partecipation in advisory boards: Celgene corporation. F.G.M. De Braud: Honoraria (self), speaker activities and partecipation in advisory boards: Amgen,Inc; Honoraria (self), speaker activities and partecipation in advisory boards: Roche; Honoraria (self), speaker activities and partecipation in advisory boards: Novartis International AG; Honoraria (self), speaker activities and partecipation in advisory boards: EMD Serono. All other authors have declared no conflicts of interest.