Abstract
Background: Biliary tract cancers (BTCs) include
cholangiocarcinoma, referring to cancers arising in the intrahepatic,
perihilar or distal biliary tree, ampulla of vater and gallbladder
carcinoma. Even after complete surgical resection, a large number
of patients with BTC develop recurrence. Whether recurrence
after surgery and de novo metastatic BTC should have comparable
stratification in first-line palliative systemic therapy studies is
unknown.
Methods: Patients who received palliative chemotherapy as
first-line treatment for advanced BTC between January 1987 and May
2014 in Princess Margaret Cancer Centre, Toronto were reviewed.
Probability of overall survival (OS) was estimated using the Kaplan-
Meier method, and independent prognostic factors for OS were
identified using the multivariable Cox-proportional hazard model.
Results: There were 171 patients with recurrent and 309 with
de novo metastatic disease. Median age at diagnosis was 62 years;
performance status<2: 436 (91%) patients, male: 262 (55%). In the
recurrent group, 102 (60%) had indwelling stents, 33 (32%) ampulla
of vater, 14 (14%) gallbladder, 55 (54%) cholangiocarcinoma. In the
de novo metastatic group, 173 (56%) had indwelling stents, primary
site was ampulla of vater in 13 (7%), gallbladder in 43 (25%),
cholangiocarcinoma in 117 (68%). Systemic treatment received
was gemcitabine/platinum doublet in 137 (29%), gemcitabine/5-
fluorouracil doublet; 186 (39%), gemcitabine; 93 (19%), other;
64 (13%). Median OS for the recurrent group who received firstline
palliative chemotherapy was 15.6 months (95%-confidence
interval [CI] 13.5-18.0) and 14.4 months (95%-CI 12.0-16.0) in the
de novo metastatic group. Multivariable analysis for OS revealed
that gallbladder as the primary site (P=0.04) and ECOG performance
status ≥ 2 (P=0.001) were prognostic for worse OS. De novo
metastatic status was not prognostic for worse OS compared with
recurrent status (Hazard ratio 0.9, 95% CI-0.66-1.23, P=0.51).
Conclusions: Similar treatment of patients with recurrent
disease after surgery and de novo metastatic BTC, with first-line
palliative chemotherapy is acceptable.
| Original language | English |
|---|---|
| Pages (from-to) | 1-5 |
| Journal | Journal of Gastroenterology, Pancreatology & Liver Disorders |
| Volume | 3 |
| DOIs | |
| Publication status | Published - 20 Oct 2016 |
Keywords
- Biliary tract cancer; Recurrent disease; De novo metastatic; Outcomes
Research Beacons, Institutes and Platforms
- Manchester Cancer Research Centre
