临床和病理分期的协调性，以及新辅助治疗（NAT）所带来的总体生存（OS）益处仍未确定。我们旨在确定分期准确性和NAT降级对肝内胆管癌（ICC）患者OS的影响。我们利用国家癌症数据库确定了2010至2018年间接受ICC治疗的患者。采用贝叶斯方法估计NAT降级。相对于治疗前就诊的分期协调/过度分期疾病，治疗前就诊的分期不足疾病，没有降级以及降级后的患者评估了OS。在3384名患者中，2904名（85.8％）接受了治疗前就诊的手术，而480名（14.2％）接受了NAT，其中85 / 480（18.4％）发生了降级。患有cT3疾病（比值比[OR] 2.12，95％置信区间[CI] 1.34-3.34），cN1疾病的患者（OR 2.47，95％CI 1.71-3.58）和在高容量设施接受治疗的患者（OR 1.63，95％CI 1.13-2.36）更有可能接受NAT（所有p <0.05）。中位OS为40.1个月（95％CI 38.6-43.4）。与治疗前就诊相比，cT1-2N1（NAT：31.5个月vs治疗前就诊：22.4个月；p = 0.04）和cT3-4N1（NAT：27.8个月vs治疗前就诊：14.4个月；p = 0.01）疾病的患者从NAT中受益最大。 NAT降级降低了cT3-4N1疾病患者死亡的风险（风险比[HR] 0.35，95％CI 0.15-0.82）。相反，在治疗前就诊的cT1-2N0 / X（HR 2.15，95％CI 1.83-2.53）和cT3-4N0 / X（HR 1.71，95％CI 1.06-2.74）疾病患者中分期不足，死亡的风险增加了。NAT治疗的N1 ICC患者的OS明显优于治疗前就诊。相比治疗前就诊，NAT导致的降级对于cT3-4N1的患者具有生存益处。应该考虑在高级T疾病和/或淋巴结转移的ICC患者中使用NAT。©2023年。外科治疗学会。

Concordance between clinical and pathological staging, as well as the overall survival (OS) benefit associated with neoadjuvant therapy (NAT) remain ill-defined. We sought to determine the impact of staging accuracy and NAT downstaging on OS among patients with intrahepatic cholangiocarcinoma (ICC).Patients treated for ICC between 2010 and 2018 were identified using the National Cancer Database. A Bayesian approach was applied to estimate NAT downstaging. OS was assessed relative to staging concordant/overstaged disease treated with upfront surgery, understaged disease treated with upfront surgery, no downstaging, and downstaging after NAT.Among 3384 patients, 2904 (85.8%) underwent upfront surgery, whereas 480 (14.2%) received NAT and 85/480 (18.4%) were downstaged. Patients with cT3 (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.34-3.34), cN1 (OR 2.47, 95% CI 1.71-3.58) disease, and patients treated at high-volume facilities (OR 1.63, 95% CI 1.13-2.36) were more likely to receive NAT (all p < 0.05). Median OS was 40.1 months (95% CI 38.6-43.4). Patients with cT1-2N1 (NAT: 31.5 months vs. upfront surgery: 22.4 months; p = 0.04) and cT3-4N1 (NAT: 27.8 months vs. upfront surgery: 14.4 months; p = 0.01) disease benefited most from NAT. NAT downstaging decreased the risk of death among patients with cT3-4N1 disease (hazard ratio [HR] 0.35, 95% CI 0.15-0.82). In contrast, understaged patients with cT1-2N0/X (HR 2.15, 95% CI 1.83-2.53) and cT3-4N0/X (HR 1.71, 95% CI 1.06-2.74) disease treated with upfront surgery had increased risk of death.Patients with N1 ICC treated with NAT demonstrated improved OS compared with upfront surgery. Downstaging secondary to NAT conferred survival benefits among patients with cT3-4N1 versus upfront surgery. NAT should be considered in ICC patients with advanced T disease and/or nodal metastases.© 2023. Society of Surgical Oncology.