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Neoadjuvant chemotherapy followed by surgery versus upfront surgery for intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

Yanmo Liu,Cuiyun Wu,Qifeng Huang,Yizhao Zhou,Kezhong Tang

Published 2025 in BMC Cancer

ABSTRACT

Whether neoadjuvant chemotherapy (NAT) is beneficial for resectable and locally advanced intrahepatic cholangiocarcinoma (ICC) is still controversial. This study aimed to compare the efficacy of NAT followed by surgery and upfront surgery for ICC treatment. Embase, Pubmed, Web of Science and Cochrane library databases were searched to obtain comparative studies. The non-randomized interventions (ROBINS-I) was used to assess the methodological quality of included studies. The primary outcomes included 1-year, 3-year and 5-year overall survival (OS). The secondary outcomes were R0 resection, 1-year and 3-year recurrence-free survival (RFS). Nine retrospective studies were included in the meta-analysis. A total of 8211 patients were included in the study, of whom 1836 patients received NAT followed by surgery and 6375 patients received upfront surgery. Compared with upfront surgery, NAT group had a significantly better 1-year OS (relative risk (RR) 1.09; 95%CI 1.06, 1.12. p = 0.449) and 3-year OS (RR 1.15; 95%CI 1.06, 1.24. p = 0.386). NAT group had similar results compared with upfront surgery group in 5-year OS (RR 1.16; 95%CI 0.94, 1.44. p < 0.05), 1-year RFS (RR 1.05; 95%CI 0.90, 1.23. p = 0.481), 3-year RFS (RR 1.03; 95%CI 0.82, 1.30. p = 0.969) and R0 resection rate (RR 0.94; 95%CI 0.82, 1.08. p < 0.05). Compared with upfront surgery, NAT followed by surgery had better results for resectable and locally advanced ICC. Considering the patients in NAT followed by surgery group had more advanced ICC cases, NAT followed by surgery might be a rationale choice for ICC treatment. Further studies about effective downstage treatments for locally advantage ICC are needed in future.

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