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Prognostic Factors After Surgical Resection for Patients With Biliary Tract Cancer
Tetsuo Ajiki*, Kenta Shinozaki, Taku Matsumoto, Tadahiro Goto, Sadaki Asari, Hirochika Toyama, Takumi Fukumoto, Yonson Ku
Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
Background: The prognosis of patients with biliary tract cancer (BTC) is unsatisfactory. New therapeutic strategies are required to improve the long-term survival. Recently, gemcitabine (GEM) was approved as an effective chemotherapeutic agent for BTC. However, the role of adjuvant chemotherapy with GEM in survival of resectable BTC is unclear. The aim of this study was to identify useful prognostic factors, including adjuvant GEM chemotherapy, for BTC.
Methods: A retrospective review of a database of 138 patients (28 intrahepatic BTC, 80 extrahepatic BTC, 30 gallbladder cancer, M/F=88/50) who underwent curative resection between 2005 and 2012 was performed. Major hepatectomy or pancreaticoduodenectomy were performed in 94 patients (68%). Residual tumor status was 100 R0 and 38 R1. Fifty-two patients underwent adjuvant chemotherapy with intravenous GEM at a dose of 1,000 mg/m2, which was planned to be administered 18 times (once a week for 3 weeks of every 4 weeks or biweekly). The relationship between survival and clinicopathological factors was evaluated using univariate and multivariate analyses.
Results: For all patients, the overall and recurrence-free 1-, 3-, and 5-year survival rates were, 87, 51, 37% and 67, 44, 37%, respectively. Univariate analysis revealed that R0 resection (p<0.01) was significantly associated with better survival, and that patients with low UICC stage (p=0.1) and no lymph node metastasis (p=0.06) tended to show long-term survival. Multivariate analysis showed that R0 resection was independently associated with long-term survival (p<0.01). Adjuvant GEM chemotherapy was completed in 42 patients. Recurrence occurred in 36 patients (69%) with adjuvant GEM chemotherapy and in 50 patients (58%) with surgery alone. The 1-, 3-, 5-year overall survival rates of patients treated with or without adjuvant GEM chemotherapy were 96, 56, 33% and 81, 49, 41%, respectively (p=0.24).
Conclusions: R0 resection provides the best probability for long-term survival in biliary tract cancers. Although adjuvant gemcitabine chemotherapy is feasible and may provide some benefit, adjuvant GEM chemotherapy does not significantly improve survival.
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