Biliary tract cancer; a large institutional experience

Background: Biliary tract cancers (BTCs) encompass both cholangiocarcinoma (CC), arising in the intrahepatic, perihilar (klatskin), or distal biliary tree, ampulla of vater and gallbladder carcinoma (GBC). The prognosis is poor for the majority of these patients (pts). Given the rarity of BTC compared with other solid tumours, there have been few large studies looking at long-term outcomes. The aim of this study was to retrospectively review outcomes of pts who presented to a multidisciplinary team at Princess Margaret Hospital, Toronto, with a diagnosis of BTC. Methods: 950 pts with a diagnosis of BTC were followed from diagnosis to death between Jan 1987 and Sept 2011. Complete demographics, performance status, disease site, histological diagnosis, percentage receiving surgery with curative intent, other treatments and overall survival were analysed. Results: The cohort includes 497 (52%) males, performance status of 0-1 in 781 (82%) and 2-3 in 68 (7%) pts. A histological diagnosis of adenocarcinoma was confirmed in 806 (85%), 104 (11%) were non diagnostic, 40 (4%) other. Definitive surgery was performed in 42% and adjuvant chemotherapy (CT) or concurrent CT/radiotherapy given in only 7% and 4% respectively. The overall survival for the entire cohort of 950 pts was 18 months (mo) with survival for breakdown of tumour type detailed in table. At this time 319 (34%) pts are still alive, 561 (59%) are deceased and status is unknown in 70 (7%). CT or concurrent CT/radiotherapy was given for unresectable or metastatic disease in the first line palliative setting in 332 (35%) and 23 pts (2%) respectively. The response to first line CT in GB was 46% vs. 31% in CC and med survival was 12.2 and 11.2 mo respectively. Conclusions: This represents a large biliary cancer cohort with survival benchmarks obtained in the modern era of multidisciplinary care. The different sub-sites clearly have different prognosis. Responses and survival for advanced disease on CT are similar for GBC and CC. Updated data will be presented. -------------------------------------------------------------------------------- Location N % Median survival (months) -------------------------------------------------------------------------------- Gallbladder 294 31 12.2 Distal bile duct 212 22 20.9 Ampulla of vater 154 16 39.6 Klatskin 153 16 15.7 Intrahepatic 137 15 21.0 Overall 950 100 18.0 --------------------------------------------------------------------------------