title: Neither neoadjuvant nor adjuvant therapy increases survival after biliary tract cancer resection with wide negative margins.
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.
authors: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler Street, Unit 1484, Houston, TX 77030, USA.
authors: Evan S
authors: ES
authors: Glazer
authors: Ping
authors: P
authors: Liu
authors: Eddie K
authors: EK
authors: Abdalla
authors: Jean-Nicolas
authors: JN
authors: Vauthey
authors: Steven A
authors: SA
authors: Curley
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D016019:Survival Analysis