Effect of Case Discussion with Expert Centers on Treatment Outcome of Intrahepatic Cholangiocarcinoma

BACKGROUND: Intrahepatic cholangiocarcinoma (iCCA) is a rare liver malignancy with poor prognosis. This study assessed how case discussion of patients at expert centers within multidisciplinary team meetings (MDTs) is associated with treatment and survival in iCCA patients in the Netherlands. METHODS: This retrospective cohort study analyzed data registered in the Netherlands Cancer Registry between 2017 and 2021 on all consecutive patients diagnosed with iCCA. Data included patient demographics, tumor characteristics, and the involvement of a member of an expert center at case discussions. Outcomes included overall survival and treatment type, which was specified as tumor-directed (e.g., resection, ablation, systemic treatment, or other treatment modalities) vs. supportive care only. RESULTS: Among the 1.622 patients included, median overall survival was 5.4 months, and 825 (50.9%) underwent tumor-directed therapy. Patients discussed at expert centers (59.6%) were more likely to receive tumor-directed therapy (58.8% vs. 37.2%, P < 0.001) and undergo surgery (20.3% vs. 5.7%, P < 0.001). In the multivariable analysis, patients discussed at expert centers had better overall survival (hazard ratio 0.69 (0.62-0.78)). CONCLUSIONS: Centralized care through MDT discussion at expert centers was associated with increased likelihood of receiving tumor-directed therapy and improved survival in iCCA patients. This study highlights the potential for improved patient outcomes through structured expert consultations.