Miloud Azarfane1, Astrid Lièvre2, Hélène Senellart3, Brigitte Dessomme4, Pauline Guillouche5, Jérémy Meyer6, Jaafar Bennouna7, Thimothée Wallenhorst8, Maëva Salimon9, Jérôme Gournay10, Tamara Matysiak-Budnik11, Annie Lim12, Julien Edeline13, Yann Touchefeu14. 1. IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France. . miloud.azarfane@gmail.com. 2. Department of Gastroenterology, CHU Pontchaillou, Rennes 1 University; INSERM U1242, Oncogenesis, Stress and Signaling, Rennes, France. astrid.lievre@chu-rennes.fr. 3. Integrated Center for Oncology, Centre René Gauducheau, Saint Herblain, France. helene.senellart@ico.unicancer.fr. 4. Department of Public Health, University Hospital, Nantes, France. brigitte.desomme@chu-nantes.fr. 5. Department of Gastroenterology, Clinique Jules Verne, Nantes, France. pguillouche@hotmail.com. 6. Department of Radiology, University Hospital, Nantes, France. jeremy.meyer@chu-nantes.fr. 7. IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France. Jaafar.bennouna@chu-nantes.Fr. 8. Department of Gastroenterology, CHU Pontchaillou, Rennes 1 University; INSERM U1242, Oncogenesis, Stress and Signaling, Rennes, France. thimothee.wallenhorst@chu-rennes.fr. 9. IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France. maeva.salimon@chu-rennes.fr. 10. IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France. jerome.gournay@chu-nantes.fr. 11. IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France. tamara.matysiakbudnik@chu-nantes.fr. 12. Department of Gastroenterology, Clinique Santé Atlantique, Saint Herblain, France. annie.lim87@yahoo.fr. 13. Centre Eugène Marquis, Oncology Department, Rennes, France. j.edeline@rennes.unicancer.fr. 14. IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France. Yann.touchefeu@chu-nantes.fr.
Abstract
BACKGROUND AND AIMS: In unresectable biliary tract cancers, the management of biliary obstruction is often the first step before introduction of chemotherapy. Our aim was to study the predictive factors of chemotherapy initiation after biliary drainage in a series of patients presenting with advanced biliary tract cancer and obstructive jaundice. METHODS: Data of all patients treated for unresectable biliary tract cancer with initial biliary obstruction requiring a drainage in six institutions, from January 2009 to January 2019, were retrospectively collected. RESULTS: Among 82 patients included in this study (median age 68 years, men 61%), 48 (59%) received chemotherapy. Median overall survival was 4.9 months (0.2-38.7) in the group of patients who did not receive chemotherapy and 12.2 months (1.9-61.0) in chemotherapy group (HR=2.93; 95%CI: 1.6-5.3; p<0.0001). In univariate analysis, younger age, male gender, Eastern Cooperative Oncology Group (ECOG) score ≤2, high albumin level, low C-reactive protein level, and endoscopic drainage were significantly associated with introduction of chemotherapy. In multivariate analysis, only ECOG score ≤2 at diagnosis (HR=70.4; 95%CI: 4.6-1097.6; p=0.002) and male gender (HR=5; 95%CI: 1.5-16.5; p=0.009), were significant independent predictive factors of chemotherapy introduction. Age and bilirubin level at diagnosis were not significant factors in multivariate analysis. CONCLUSIONS: ECOG score ≤ 2 and male gender were the only independent predictive factors of chemotherapy introduction in unresectable biliary tract cancers. Age or initial bilirubin level were not predictors for chemotherapy introduction. These results might help defining the initial therapeutic strategy.
BACKGROUND AND AIMS: In unresectable biliary tract cancers, the management of biliary obstruction is often the first step before introduction of chemotherapy. Our aim was to study the predictive factors of chemotherapy initiation after biliary drainage in a series of patients presenting with advanced biliary tract cancer and obstructive jaundice. METHODS: Data of all patients treated for unresectable biliary tract cancer with initial biliary obstruction requiring a drainage in six institutions, from January 2009 to January 2019, were retrospectively collected. RESULTS: Among 82 patients included in this study (median age 68 years, men 61%), 48 (59%) received chemotherapy. Median overall survival was 4.9 months (0.2-38.7) in the group of patients who did not receive chemotherapy and 12.2 months (1.9-61.0) in chemotherapy group (HR=2.93; 95%CI: 1.6-5.3; p<0.0001). In univariate analysis, younger age, male gender, Eastern Cooperative Oncology Group (ECOG) score ≤2, high albumin level, low C-reactive protein level, and endoscopic drainage were significantly associated with introduction of chemotherapy. In multivariate analysis, only ECOG score ≤2 at diagnosis (HR=70.4; 95%CI: 4.6-1097.6; p=0.002) and male gender (HR=5; 95%CI: 1.5-16.5; p=0.009), were significant independent predictive factors of chemotherapy introduction. Age and bilirubin level at diagnosis were not significant factors in multivariate analysis. CONCLUSIONS: ECOG score ≤ 2 and male gender were the only independent predictive factors of chemotherapy introduction in unresectable biliary tract cancers. Age or initial bilirubin level were not predictors for chemotherapy introduction. These results might help defining the initial therapeutic strategy.