Predictive factors for chemotherapy response in patients with advanced Cholangiocarcinoma receiving frontline chemotherapy

Abstract

Cholangiocarcinoma is the first and most common cancer in the northeastern region of Thailand and the leading cause of death. Factors predicting response to chemotherapy, such as gene expression, were studied, but could not be tested in general hospitals. We aim to investigate the predicting factors in Thai patients with advanced/metastatic cholangiocarcinoma who underwent chemotherapy in real practice and to determine the prognostic factors that affect progression-free survival. This study was a retrospective cohort study of advanced/metastatic cholangiocarcinoma patients with frontline chemotherapy treatment conducted from October 2017 to October 2021 by collecting data from medical records of Sisaket Hospital. Data were analyzed using descriptive statistics, Pearson’s chi-square, univariate and multivariate analyses, exact probability, Cox’s proportional hazard analysis, and the Kaplan-Meier method. Of 56 patients with cholangiocarcinoma, the median age was 61.3 years. The study found that 73.2% were intrahepatic cholangiocarcinoma and 80.4% were metastasis; most of which spread to intra-abdominal lymph nodes (33.3%) and liver (22.7%). Response to chemotherapy was 55.4%. Median progression-free survival (PSF) was 6.5 months. There was no difference in the chemotherapy-responsive group compared with the unresponsive group. In univariate analysis, ALT, CA19-9, and platelet lymphocyte ratio were significant prognostic factors for progression-free survival (PFS) while p-values were considered as 0.016, 0.033, and 0.032, respectively. However, only CA19-9 was an independent poor prognostic factor for PFS when using multivariate analysis (p-value= 0.048). These findings suggested no factors were found to predict response to chemotherapy. However, the most significant prognostic factor affecting the duration of disease control was CA19-9.