Objective  Exploring the impact of postoperative transarterial infusion (TAI) and systemic adjuvant therapy on the prognosis of patients with hilar cholangiocarcinoma (HCCA) who have undergone R1 resection.

Methods  Retrospectively analyze the clinical data of HCCA patients who underwent R1 surgical resection at The Second Affiliated Hospital of Kunming Medical University from July 2015 to December 2023. According to postoperative adjuvant treatment methods, they were divided into the surgery-only group, the TAI-based adjuvant therapy group, and the systemic adjuvant therapy group. Kaplan-Meier method was used to plot overall survival (OS) and progression-free survival (PFS) curves, the Log-rank test was used to compare intergroup differences, and the Cox proportional hazards model was used to analyze independent prognostic factors affecting OS and PFS.

Results  A total of 74 HCCA patients with R1 resection were included, 32 in the surgery-only group, 21 in the TAI-based adjuvant therapy group, and 21 in the systemic adjuvant therapy group. The median OS was 11.0 months [95%CI (7.3, 37.9)], 34.0 months [95%CI (30.8, 63.5)], and 33.0 months [95%CI (30.1, 62.8)], respectively. The median OS in the surgery- only group was significantly lower than that in the TAI-based adjuvant therapy group and the systemic adjuvant therapy group (P<0.05). Multivariate Cox regression analysis revealed that, compared with the surgery-only group, TAI-based adjuvant therapy [HR=0.406, 95%CI (0.190, 0.868), P=0.021] and systemic adjuvant therapy [HR=0.414, 95%CI (0.197, 0.873), P=0.020] were independent protective factors for OS. The median PFS for the surgery-only group, TAI-based adjuvant therapy group, and systemic adjuvant therapy group was 8.0 months [95%CI (6.9, 26.6)], 14.0 months [95%CI (9.5, 29.9)], and 28.0 months [95%CI (21.2, 38.5)], respectively. The median PFS in the surgery-only group was significantly lower than that in the systemic adjuvant therapy group (P<0.05). Multivariate Cox regression analysis indicated that, compared with the surgery-only group, systemic adjuvant therapy [HR=0.446, 95%CI (0.226, 0.879), P=0.020] was an independent protective factor for PFS.

Conclusion  Among patients with R1 resection of HCCA, postoperative systemic adjuvant therapy significantly prolonged both OS and PFS compared with no adjutant therapy, while TAI significantly prolonged OS but not PFS.

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