title: Improvement of prognosis for unresectable biliary tract cancer.
abstract: OBJECTIVE
  To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.
  
  
  METHODS
  A total of 186 consecutive patients with unresectable biliary tract cancer, who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan, were retrospectively analyzed. These patients were divided into three groups based on the year beginning chemotherapy: Group A (2000-2003), Group B (2004-2006), and Group C (2007-2009). The data were fixed at the end of December 2011. Overall survival and time-to-progression were analyzed and compared chronologically.
  
  
  RESULTS
  No patient characteristics were significantly different among the three groups. The gallbladder was involved in about half of the patients in each group, and metastatic biliary tract cancer was present in three quarters of the enrollees. In Group A, 5-fluorouracil-based chemotherapies were primarily selected as first-line chemotherapy, and only 24% were treated with second-line chemotherapy. In Group B, gemcitabine or S-1 monotherapy was mainly introduced as first-line chemotherapy, and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with monotherapy. In Group C, the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy, and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination therapy. The median time-to-progressions were 4.4 mo, 3.5 mo and 5.9 mo in Groups A, B and C, respectively (4.4 mo vs 3.5 mo vs 5.9 mo, P < 0.01). The median overall survivals were 7.1, 7.3, and 11.7 mo in Groups A, B and C (7.1 mo vs 7.3 mo vs 11.7 mo, P = 0.03). Induction rates of all three drugs (gemcitabine, platinum analogs, and fluoropyrimidine) in Groups A, B and C were 4%, 2% and 27% (4% vs 2% vs 27%, P < 0.01).
  
  
  CONCLUSIONS
  The prognosis of unresectable biliary tract cancer has improved recently. Using three effective drugs (gemcitabine, platinum analogs, and fluoropyrimidine) may improve the prognosis of this cancer.
authors: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan. sasakit-tky@umin.ac.jp
authors: Takashi
authors: T
authors: Sasaki
authors: Hiroyuki
authors: H
authors: Isayama
authors: Yousuke
authors: Y
authors: Nakai
authors: Naminatsu
authors: N
authors: Takahara
authors: Naoki
authors: N
authors: Sasahira
authors: Hirofumi
authors: H
authors: Kogure
authors: Suguru
authors: S
authors: Mizuno
authors: Hiroshi
authors: H
authors: Yagioka
authors: Yukiko
authors: Y
authors: Ito
authors: Natsuyo
authors: N
authors: Yamamoto
authors: Kenji
authors: K
authors: Hirano
authors: Nobuo
authors: N
authors: Toda
authors: Minoru
authors: M
authors: Tada
authors: Masao
authors: M
authors: Omata
authors: Kazuhiko
authors: K
authors: Koike
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005706:Gallbladder Neoplasms / Q000188:drug therapy; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine
keywords: Biliary tract cancer; Fluoropyrimidine; Gemcitabine; Platinum analogs; Unresectable