OBJECTIVE: There are high rates of recurrence after definitive surgery in biliary tract cancer patients. We reviewed the use and effectiveness of adjuvant therapy (AT; chemotherapy±radiotherapy) in a single institution series. METHODS: Characteristics, treatment details, and follow-up data of all patients with biliary tract cancer who had definitive surgery from January 1987 to September 2011 were reviewed. The association between baseline variables and disease-free survival/overall survival (OS) were tested using Cox proportional hazard analysis in the univariable and multivariable settings. RESULTS: Analysis included 296 patients (58% male; median age, 63 y). Negative or microscopically positive resections were reported in 42% and 14%, respectively, with 44% not reported. Node positivity was reported in 35% patients. AT was given in 28% of patients with 59% receiving chemotherapy and 35% concurrent chemotherapy/radiotherapy. Disease recurred in 60% patients. AT was associated with significantly improved OS (hazard ratio, 0.41; P=0.02). Compared with R0 resection, patients with R1 resection derived significantly increased benefit from AT (P for difference 0.02). In the node positive population (n=103), AT was associated with significantly improved OS (hazard ratio, 0.60; 95% confidence interval, 0.38-0.95; P=0.03). CONCLUSIONS: Patients with R1 resection and node positive disease receiving AT after definitive surgery seem to derive OS advantage. Large prospective trials are needed to confirm these data.
OBJECTIVE: There are high rates of recurrence after definitive surgery in biliary tract cancerpatients. We reviewed the use and effectiveness of adjuvant therapy (AT; chemotherapy±radiotherapy) in a single institution series. METHODS: Characteristics, treatment details, and follow-up data of all patients with biliary tract cancer who had definitive surgery from January 1987 to September 2011 were reviewed. The association between baseline variables and disease-free survival/overall survival (OS) were tested using Cox proportional hazard analysis in the univariable and multivariable settings. RESULTS: Analysis included 296 patients (58% male; median age, 63 y). Negative or microscopically positive resections were reported in 42% and 14%, respectively, with 44% not reported. Node positivity was reported in 35% patients. AT was given in 28% of patients with 59% receiving chemotherapy and 35% concurrent chemotherapy/radiotherapy. Disease recurred in 60% patients. AT was associated with significantly improved OS (hazard ratio, 0.41; P=0.02). Compared with R0 resection, patients with R1 resection derived significantly increased benefit from AT (P for difference 0.02). In the node positive population (n=103), AT was associated with significantly improved OS (hazard ratio, 0.60; 95% confidence interval, 0.38-0.95; P=0.03). CONCLUSIONS:Patients with R1 resection and node positive disease receiving AT after definitive surgery seem to derive OS advantage. Large prospective trials are needed to confirm these data.
Authors: Yuhree Kim; Neda Amini; Ana Wilson; Georgios A Margonis; Cecilia G Ethun; George Poultsides; Thuy Tran; Kamran Idrees; Chelsea A Isom; Ryan C Fields; Bradley Krasnick; Sharon M Weber; Ahmed Salem; Robert C G Martin; Charles Scoggins; Perry Shen; Harveshp D Mogal; Carl Schmidt; Eliza Beal; Ioannis Hatzaras; Rivfka Shenoy; Kenneth Cardona; Shishir K Maithel; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2016-05-11 Impact factor: 5.344
Authors: Ariella M Altman; Scott Kizy; Schelomo Marmor; Jane Y C Hui; Todd M Tuttle; Eric H Jensen; Jason W Denbo Journal: Hepatobiliary Surg Nutr Date: 2020-10 Impact factor: 7.293
Authors: Caitlin Hester; Ibrahim Nassour; Beverley Adams-Huet; Mathew Augustine; Michael A Choti; Rebecca M Minter; John C Mansour; Patricio M Polanco; Matthew R Porembka; Sam C Wang; Adam C Yopp Journal: J Gastrointest Surg Date: 2018-07-20 Impact factor: 3.452