Cancer Res Treat.  2016 Apr;48(2):583-595. 10.4143/crt.2015.091.

Surgery Alone Versus Surgery Followed by Chemotherapy and Radiotherapy in Resected Extrahepatic Bile Duct Cancer: Treatment Outcome Analysis of 336 Patients

• Im JH
• Seong J
• Lee IJ
• Park JS
• Yoon DS
• Kim KS
• Lee WJ
• Park KR

• KMID: 2454336
• DOI: http://doi.org/10.4143/crt.2015.091

Abstract

PURPOSE
This study analyzed the outcomes of patients with resected extrahepatic bile duct cancer (EHBDC) in order to clarify the role of adjuvant treatments in these patients.
MATERIALS AND METHODS
A total of 336 patients with EHBDC who underwent curative resection between 2001 and 2010 were analyzed retrospectively. The treatment types were as follows: surgery alone (n=168), surgery with chemotherapy (CTx, n=90), surgery with radiotherapy (RT) alone (n=29), and surgery with chemoradiotherapy (CRT, n=49).
RESULTS
The median follow-up period was 63 months. The 5-year rates of locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) for all patients were 56.5%, 59.7%, 36.6%, and 42.0%, respectively. In multivariate analysis, surgery with RT and CRT was a significant prognostic factor for LRFFS, and surgery with CTx was a significant prognostic factor for DMFS, and surgery with CTx, RT, and CRT was a significant prognostic factor for PFS (p < 0.05). Surgery with CTx and CRT showed association with superior OS (p < 0.05), and surgery with RT had marginal significance (p=0.078). In multivariate analysis of the R1 resection patients, surgery with CRT showed significant association with OS (p < 0.05).
CONCLUSION
Adjuvant RT and CTx may be helpful in improving clinical outcomes of patients with resected EHBDC who have a high risk of disease recurrence, particularly R1 resection patients. Conduct of additional prospective, larger-scale studies will be required in order to confirm the benefit of adjuvant RT and CTx in these patients.

Keyword

Extrahepatic bile duct cancer; Cholangiocarcinoma; Adjuvant radiotherapy; Drug therapy; Survival; Biliary tract neoplasms

MeSH Terms

Bile Ducts, Extrahepatic*
Biliary Tract Neoplasms
Chemoradiotherapy
Cholangiocarcinoma
Disease-Free Survival
Drug Therapy*
Follow-Up Studies
Humans
Multivariate Analysis
Prospective Studies
Radiotherapy*
Radiotherapy, Adjuvant
Recurrence
Retrospective Studies
Treatment Outcome*

Figure

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  Fig. 1. Comparison of survival curves according to treatment type in patients with R1 resection. CRT, chemoradiotherapy; RT, radiotherapy; CTx, chemotherapy.

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  Fig. 2. Combined comparison of survival curves according to treatment type (surgery alone and surgery with chemotherapy vs. surgery with radiotherapy [RT] and surgery with chemoradiotherapy) in patients with R1 resection.

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  Fig. 3. Combined comparison of survival curves according to treatment type (surgery alone and surgery with radiotherapy vs. surgery with chemotherapy [CTx] and surgery with chemoradiotherapy) in patients with R1 resection.

Reference

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