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The efficiency and regimen choice of adjuvant chemotherapy in biliary tract cancer: A STROBE-compliant retrospective cohort study.

ABSTRACT: Biliary tract cancer (BTC) patients have poor prognosis even following radical resection. To improve the current status, more evidence is required clarifying the role of adjuvant chemotherapy. This study aim is to evaluate the efficacy of adjuvant chemotherapy and discuss the regimen choices.We retrospectively analyzed the clinical data of 80 patients who underwent curative-intent R0 resection from 2008 to 2016. Among them, 40 patients had received adjuvant chemotherapy, and the others in the observation group were 1:1 matched by clinical characteristics including gender, age, tumor stage, and ECOG performance status score. Kaplan-Meier analysis was performed to compare DFS and OS. Potential confounding factors were adjusted by Multivariate analysis.In the entire patient cohort, the mean disease-free survival (DFS) time of BTC patients with adjuvant chemotherapy and observation was 18.63?±?3.63 months versus 10.36?±?1.67 months, respectively (P?=?.029). There was no significant difference observed in overall survival (OS) time (33.72?±?5.02 vs 21.05?±?4.12 months, P?=?.114). On multivariate analysis, adjuvant chemotherapy and N factor were found to be significant factors for DFS, and sex, age, T factor were found to be significant factors for OS. Besides, subgroup analysis indicated that combination chemotherapy prolonged DFS time of BTC patients than single-agent to some extent, and oral agents showed efficacy to improve OS.This retrospective study demonstrates that adjuvant chemotherapy contributes to DFS, but is unsatisfactory for improving OS. Combination chemotherapy contained oral agents provides a possibility of therapeutic strategy for improving surgical outcomes of BTC patients.

SUBMITTER: Yin L

PROVIDER: S-EPMC6320011 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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The efficiency and regimen choice of adjuvant chemotherapy in biliary tract cancer: A STROBE-compliant retrospective cohort study.

Yin Luxi L Xu Qi Q Li Jingjing J Wei Qing Q Ying Jieer J

Medicine 20181201 50

Biliary tract cancer (BTC) patients have poor prognosis even following radical resection. To improve the current status, more evidence is required clarifying the role of adjuvant chemotherapy. This study aim is to evaluate the efficacy of adjuvant chemotherapy and discuss the regimen choices.We retrospectively analyzed the clinical data of 80 patients who underwent curative-intent R0 resection from 2008 to 2016. Among them, 40 patients had received adjuvant chemotherapy, and the others in the ob ...[more]

PMID: 30558021

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Project description:ImportanceThe association of adjuvant chemotherapy (AC) with survival in the general population of patients with resected biliary tract cancer (BTC) remains controversial. As such, the role of this treatment in the treatment of older adult patients (aged ≥70 years) needs to be evaluated.ObjectiveTo describe the patterns of use of AC and compare survival outcomes of AC and observation in older adult patients following resection of BTC.Design, setting, and participantsThis retrospective cohort study included 8091 older adult patients with resected BTC with data available in the National Cancer Database from January 1, 2004, to December 31, 2019. Patients were divided into 2 cohorts: AC and observation. The AC cohort was subdivided into single-agent and multiagent AC treatment.ExposuresAdjuvant chemotherapy vs observation following BTC resection.Main outcomes and measuresThe primary outcome was overall survival (OS) of patients who received AC compared with observation following resection of BTC as evaluated using Kaplan-Meier estimates and multivariable Cox proportional hazards regression models. Inverse probability of treatment weighting and propensity score matching were performed to address indication bias.ResultsBetween 2004 and 2019, of 8091 older adult patients with resected BTC identified (median [range] age, 77 [70-90] years; 5136 women [63.5%]; 2955 men [36.5%]), only one-third (2632 [32.5%]) received AC. There was an increase in the use of AC across the study period from 20.7% (n = 495) in 2004 to 2009 to 41.2% (n = 856) in 2016 to 2019. Age 80 years or older (odds ratio, 0.29; 95% CI, 0.25-0.33; P < .001) and gallbladder primary site (odds ratio, 0.71; 95% CI, 0.61-0.83; P < .001) were associated with a lower odds of AC. Following inverse probability of treatment weighting, as a composite, AC was not associated with improved survival (median OS, 20.5 months; 95% CI, 19.2-21.7 months) compared with observation (median OS, 19.0 months; 95% CI, 18.1-20.3 months). A longer median OS was associated with single-agent AC (21.5 months; 95% CI, 19.9-24.0 months) but not multiagent AC (19.1 months; 95% CI, 17.5-21.1 months) compared with observation (median OS, 17.3 months; 95% CI, 16.1-18.4 months). This improvement in OS with single-agent AC was not apparent on multivariable analysis (hazard ratio [HR], 0.97; 95% CI, 0.89-1.05; P = .44). However, age at diagnosis of 80 years or older (HR, 1.35; 95% CI, 1.28-1.42; P < .001) and treatment at nonacademic centers (HR, 1.14; 95% CI, 1.07-1.20, P < .001) were associated with worse OS.Conclusions and relevanceIn this cohort study of older adult patients, AC was not associated with an improvement in survival compared with observation following BTC resection. These findings suggest the need for further study of AC for older adult patients who may benefit after curative intent surgery for BTC.

Project description:BackgroundComplete resection followed by adjuvant chemotherapy is the gold standard for patients with localized cholangiocarcinoma (CC) or gallbladder cancer (GBC). However, this is not always feasible, and recurrence rates remain high.ObjectivesTo understand the real-world proportions and reason for treatment failure in resected biliary tract cancers.Design and methodsWe performed a retrospective population-based review of patients with GBC or CC [intrahepatic (IHCC) or extrahepatic (EHCC)] resected between 2005 and 2019 using the BC Cancer provincial database. A chart review was conducted to characterize demographics, treatments received and outcomes.ResultsIn total, 594 patients were identified of whom 416 (70%) had disease recurrence. Most GBCs (96%) were diagnosed incidentally, and repeat oncologic resection was performed in 45%. Adjuvant chemotherapy was received in 51% of patients diagnosed after 2017 (mostly capecitabine). Patient co-morbidities, disease progression and patient preference were the commonest reasons for not proceeding with adjuvant chemotherapy. One-third of patients did not complete all planned cycles. Median overall survival was significantly higher in those with complete (R0) versus incomplete (R1) resection [31.6 versus 18 months, hazard ratio (HR): 0.43, 95% confidence interval (CI): 0.35-0.53] and in those with versus without re-resection for GBC [29.4 versus 19 months, HR: 0.55, 95% CI: 0.41-0.73]. There was a trend towards improved survival with versus without adjuvant therapy (HR: 0.79, 95% CI: 0.61-1.02). Only 25% in the more contemporary cohort (2017-2019) had an R0 resection and completed adjuvant chemotherapy.ConclusionComplete resection, including reresection for incidentally diagnosed GBCs, and adjuvant chemotherapy were associated with improved outcomes in this retrospective cohort, yet many patients were not able to complete these treatments. Neoadjuvant strategies may improve treatment delivery and ultimately, outcomes.

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The efficiency and regimen choice of adjuvant chemotherapy in biliary tract cancer: A STROBE-compliant retrospective cohort study.

Publications

The efficiency and regimen choice of adjuvant chemotherapy in biliary tract cancer: A STROBE-compliant retrospective cohort study.

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