Adjuvant Therapy After Resection of Extrahepatic Bile Ducts

Identification of Patients for Adjuvant Therapy After Resection of Carcinoma of
the Extrahepatic Bile Ducts: A Propensity Score-Matched Analysis.

Ann Surg Oncol. 2017 Sep 26. doi: 10.1245/s10434-017-6095-9. [Epub ahead of
print]

Ecker BL(1), Vining CC(1), Roses RE(1), Maggino L(1)(2), Lee MK(1), Drebin JA(3),
Fraker DL(1), Vollmer CM Jr(1), Datta J(4)(5).

Author information:
(1)Department of Surgery, University of Pennsylvania Perelman School of Medicine,
Philadelphia, PA, USA.
(2)Department of Surgery, Pancreas Institute, University of Verona, Verona,
Italy.
(3)Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY,
USA.
(4)Department of Surgery, University of Pennsylvania Perelman School of Medicine,
Philadelphia, PA, USA. jash.datta@gmail.com.
(5)Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY,
USA. jash.datta@gmail.com.

BACKGROUND: Resectability rates for extrahepatic cholangiocarcinoma have
increased over time, but long-term survival after resection alone with curative
intent remains poor. Recent series suggest improved survival with adjuvant
therapy. Patient subsets benefiting most from adjuvant therapy have not been
clearly defined.
METHODS: Patients with extrahepatic cholangiocarcinoma who underwent resection
with curative intent and received adjuvant therapy (chemotherapy ± radiotherapy)
or surgery alone (SA) were identified in the U.S. National Cancer Data Base
(2004-2014). Cox regression identified covariates associated with overall
survival (OS). Adjuvant therapy and SA cohorts were matched (1:1) by propensity
scores based on the survival hazard in Cox modeling. Overall survival was
compared by Kaplan-Meier estimates.
RESULTS: Of 4872 patients, adjuvant chemotherapy was used frequently for 2416
(49.6%), often in conjunction with radiotherapy (RT) (n = 1555, 64.4%). Adjuvant
chemotherapy with or without RT was used increasingly for cases with higher T
classification [reference: T1-2; T3: 1.36; 95% confidence interval (CI),
1.19-1.55; T4: 1.77; 95% CI 1.38-2.26], nodal positivity [odds ratio (OR), 1.26;
95% CI 1.01-1.56], lymphovascular invasion (OR 1.21; 95% CI 1.01-1.46), or
margin-positive resection (OR 1.85; 95% CI 1.61-2.12), and was associated with
significant improvements in OS for each high-risk subset in the propensity
score-matched cohort. Adjuvant therapy was associated with improved median OS for
hilar tumors (40.0 vs 30.6 months; p = 0.025) but not distal tumors (33.0 vs
30.3 months; p = 0.123). Chemoradiotherapy was associated with superior outcomes
compared with chemotherapy alone in the subset of margin-positive resection
[hazard ratio (HR), 0.63; 95% CI 0.42-0.94].
CONCLUSIONS: Adjuvant multimodality therapy is associated with improved survival
for patients with resected extrahepatic cholangiocarcinoma and high-risk
features.

DOI: 10.1245/s10434-017-6095-9
PMID: 28952140

https://www.ncbi.nlm.nih.gov/pubmed/?term=28952140