R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer.
BACKGROUND
There is a need for better management strategies to improve the survival and quality of life in patients with biliary tract cancer (BTC).


OBJECTIVE
To assess prognostic factors for survival in a large, non-selective cohort of patients with BTC.


METHODS
We compared outcomes in 321 patients with a final diagnosis of BTC (cholangiocarcinoma n = 237, gallbladder cancer n = 84) seen in a tertiary referral cancer centre between 1998 and 2007. Survival according to disease stage and treatment category was compared using log-rank testing. Cox's regression analysis was used to determine independent prognostic factors.


RESULTS
Eighty-nine (28%) patients underwent a surgical intervention with curative intent, of whom 38% had R0 resections. Among the 321 patients, 34% were given chemo- and/or radiotherapy, 14% were palliated with photodynamic therapy (PDT) and 37% with biliary drainage procedures alone. The overall median survival was 9 months (3-year survival, 14%). R0-resective surgery conferred the most favourable outcome (3-year survival, 57%). Although patients palliated with PDT had more advanced clinical T-stages, their survival was similar to those treated with attempted curative surgery but who had positive resection margins. On multivariable analysis, treatment modality, serum carbohydrate-associated antigen 19-9, distant metastases and vascular involvement were independent prognostic indicators of survival.


CONCLUSIONS
In this large UK series of BTC, palliative PDT resulted in survival similar to those with curatively intended R1/R2 resections. Surgery conferred a survival advantage only in patients with R0 resection margins, emphasising the need for accurate pre-operative staging.
Matull
Wolf-Rudiger
WR
UCL Institute of Hepatology, UCL Faculty of Biomedical Sciences, University College London, London, UK.
Dhar
Dipok K
DK
Ayaru
Lakshmana
L
Sandanayake
Neomal S
NS
Chapman
Michael H
MH
Dias
Aruna
A
Bridgewater
John
J
Webster
George J M
GJ
Bong
Jin J
JJ
Davidson
Brian R
BR
Pereira
Stephen P
SP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001662:Biliary Tract Surgical Procedures; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004322:Drainage; D005260:Female; D005706:Gallbladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010778:Photochemotherapy; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome