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. 2012 Sep;16(9):1666-71.
doi: 10.1007/s11605-012-1935-1. Epub 2012 Jul 10.

Neither neoadjuvant nor adjuvant therapy increases survival after biliary tract cancer resection with wide negative margins

Evan S Glazer  1 , Ping Liu, Eddie K Abdalla, Jean-Nicolas Vauthey, Steven A Curley
Affiliations

Neither neoadjuvant nor adjuvant therapy increases survival after biliary tract cancer resection with wide negative margins

Evan S Glazer et al. J Gastrointest Surg. 2012 Sep.

Abstract

Background: We investigated the role of neoadjuvant/adjuvant therapies on survival for resectable biliary tract cancer. We hypothesized that neoadjuvant and adjuvant therapy should improve the survival probability in these patients.

Methods: This was a retrospective review of a prospective database of patients resected for gallbladder cancer (GBC) and cholangiocarcinoma (CC). One hundred fifty-seven patients underwent resection for primary GBC (n = 63) and CC (n = 94). Fisher's exact test, Student's t test, the log-rank test, and a Cox proportional hazard model determined significant differences.

Results: The 5-year overall survival rate after resection of GBC and CC was 50.6 % and 30.4 %, respectively. Of the patients, 17.8 % received neoadjuvant chemotherapy, 48.7 % received adjuvant chemotherapy, while 15.8 % received adjuvant chemoradiotherapy. Patients with negative margins of at least 1 cm had a 5-year survival rate of 52.4 % (p < 0.01). Adjuvant therapy did not significantly prolong survival. Neoadjuvant therapy delayed surgical resection on average for 6.8 months (p < 0.0001). Immediate resection increased median survival from 42.3 to 53.5 months (p = 0.01).

Conclusions: Early surgical resection of biliary tract malignancies with 1 cm tumor-free margins provides the best probability for long-term survival. Currently available neoadjuvant or adjuvant therapy does not improve survival.

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Figures

Fig. 1
Fig. 1
Survival of intra- and extrahepatic cholangiocarcinoma (CC) was similar for nearly the first 10 years after resection and not statistically different from each other or gallbladder cancer (GBC) (log rank p=0.87)
Fig. 2
Fig. 2
Kaplan–Meier analysis demonstrates that neither neoadjuvant (a log rank p=0.59) nor adjuvant (b log rank p=0.16) therapy is associated with an improved probability of survival. However, adjuvant chemotherapy is associated with a significant decrease in survival (b p=0.04)
Fig. 3
Fig. 3
Kaplan–Meier analysis of margin status demonstrates similar initial survival after resection of biliary cancer (log rank p=0.45). However, on multivariate analysis, margins larger than 1 cm significantly improve survival probability compared to smaller margins (p<0.01)
See this image and copyright information in PMC

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