title: Prognostic factors and predictive model in patients with advanced biliary tract adenocarcinoma receiving first-line palliative chemotherapy.
abstract: BACKGROUND
  Advanced biliary tract adenocarcinoma (BTA) has been a rare but fatal cancer. If unresectable, palliative chemotherapy improved the quality and length of life, but to the authors' knowledge, prognostic factors in such patients have not been well established to date. In the current study, prognostic factors were investigated in patients with advanced BTA receiving first-line palliative chemotherapy.
  
  
  METHODS
  Data from 213 patients with advanced BTA who were in prospective phase 2 or retrospective studies from September 2000 through October 2007 were used.
  
  
  RESULTS
  With a median follow-up duration of 29.7 months, the median overall survival (OS) was 7.3 months (95% confidence interval [95% CI], 6.3 months-8.3 months). A Cox proportional hazards model indicated that metastatic disease (hazards ratio [HR], 1.521; P=.011), intrahepatic cholangiocellular carcinoma (HR, 1.368; P=.045), liver metastasis (HR, 1.845; P<.001), Eastern Cooperative Oncology Group performance status (HR, 1.707; P<.001), and alkaline phosphatase level (IU/L) (HR, 1.001; P<.001) were statistically significant independent predictors of poor prognosis. Patients were classified into 3 risk groups based on the prognostic index (PI), which was constructed using the regression coefficients of each variable. The median OS was 11.5 months (95% CI, 9.6 months-13.5 months) for the low-risk group (PI<or=1.5; n=67), 7.3 months (95% CI, 5.7 months-8.9 months) for the intermediate-risk group (PI>1.5 but <or=2.2; n=75), and 3.6 months (95% CI, 2.9 months-4.1 months) for the high-risk group (PI>2.2; n=70 [P<.001]).
  
  
  CONCLUSIONS
  Five prognostic factors in patients with advanced BTA were identified. The predictive model based on PI appears to be promising and may be used for the management of individual patients and to guide the design of future clinical trials, although external validation is needed.
authors.affiliation: Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Inkeun
authors.initials: I
authors.lastname: Park
authors.forename: Jae-Lyun
authors.initials: JL
authors.lastname: Lee
authors.forename: Min-Hee
authors.initials: MH
authors.lastname: Ryu
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kim
authors.forename: Sung
authors.initials: S
authors.lastname: Sook Lee
authors.forename: Do
authors.initials: D
authors.lastname: Hyun Park
authors.forename: Sang
authors.initials: S
authors.lastname: Soo Lee
authors.forename: Dong
authors.initials: D
authors.lastname: Wan Seo
authors.forename: Sung
authors.initials: S
authors.lastname: Koo Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017322:Clinical Trials, Phase II as Topic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis