Abstract： Objectives:To examine the influence of adjuvant chemotherapy after radical resection on the survival of patients with intrahepatic cholangiocarcinoma(ICC) and identify patients who may benefit from it.Methods:The clinical and pathological data of 654 patients with ICC diagnosed by postoperative pathology from December 2011 to December 2017 were collected retrospectively in 13 hospitals in China. According to inclusion and exclusion criteria,455 patients were included in this study,including 69 patients (15.2%) who received adjuvant chemotherapy and 386 patients (84.8%) who did not receive adjuvant chemotherapy. There were 278 males and 177 females,with an age of 59 (16) years ( M(IQR))(range:23 to 88 years). The propensity score matching (PSM) method was used to balance the difference between the adjuvant chemotherapy group and the non-adjuvant chemotherapy group. The Kaplan-Meier method was used to plot the survival curve,the Log-rank test was used to compare the difference of overall survival(OS) and recurrence free survival(RFS) between the two groups. Univariate analysis was used to determine prognostic factors for OS. Then, multivariate Cox proportional hazards models were performed for prognostic factors with P<0.10 to identify potential independent risk factors. The study population was stratified by included study variables and the AJCC staging system,and a subgroup analysis was performed using the Kaplan-Meier method to explore the potential benefit subgroup population of adjuvant chemotherapy. Results:After 1∶1 PSM matching,69 patients were obtained in each group. There were no significant differences in baseline data between the two groups (all P>0.05). After PSM, the Cox multivariate analysis showed that lymph node metastasis ( HR=3.06,95% CI:1.52 to 6.16, P=0.039),width of resection margin ( HR=0.56,95% CI:0.32 to 0.99, P=0.044) and adjuvant chemotherapy ( HR=0.51,95% CI:0.29 to 0.91, P=0.022) were independent prognostic factors for OS. Kaplan-Meier analysis showed that the median OS time of the adjuvant chemotherapy group was significantly longer than that of the non-adjuvant chemotherapy group ( P<0.05). There were no significant differences in the RFS time between the adjuvant chemotherapy group and the non-adjuvant chemotherapy group ( P>0.05). The subgroup analysis showed that the OS of female patients,without HBV infection,carcinoembryonic antigen<9.6 μg/L,CA19-9≥200 U/ml,intraoperative bleeding<400 ml,tumor diameter>5 cm, negative microvascular invasion, without lymph node metastasis,and AJCC stage Ⅲ patients could benefit from adjuvant chemotherapy (all P<0.05). Conclusion:Adjuvant chemotherapy can prolong the OS time in patients with ICC after radical resection,and patients with tumor diameter>5 cm,without lymph node metastasis,AJCC stage Ⅲ,and negative microvascular invasion are more likely to benefit from adjuvant chemotherapy.