title: A single-center analysis of the survival benefits of adjuvant gemcitabine chemotherapy for biliary tract cancer.
abstract: BACKGROUND
  Surgical resection is the only curative treatment of biliary tract cancer (BTC). However, the prognosis of BTC remains unsatisfactory. The aim of this study is to evaluate the benefits of adjuvant gemcitabine chemotherapy for BTC.
  
  
  METHODS
  We performed a historical cohort study that involved 198 patients who underwent R0 surgical resection. Patients who underwent major hepatectomy were administered biweekly intravenous gemcitabine at a dose of 800 mg/m(2). Otherwise, patients were administered intravenous gemcitabine at a dose of 1,000 mg/m(2) in 3 weekly infusions, which were followed by a 1-week pause. The primary outcome was overall survival. The hazard ratio (HR) of adjuvant chemotherapy was estimated by propensity score-stratified Cox regression that was adjusted for confounders.
  
  
  RESULTS
  Forty patients received adjuvant chemotherapy. The HR of adjuvant chemotherapy was 0.47 [95 % confidence interval (CI) 0.28-0.95; P = 0.03]. Subgroup analysis showed that the survival benefits were possibly modified by lymph node positivity (HR 0.19; 95 % CI 0.07-0.58; interaction, P = 0.22), stage III (HR 0.11; 95 % CI 0.02-0.50; interaction, P < 0.01), intrahepatic cholangiocarcinoma (ICC) (HR 0.09; 95 % CI 0.01-0.67; interaction, P = 0.05), and poorly differentiated tumor (HR 0.16; 95 % CI 0.03-0.85; interaction, P = 0.13).
  
  
  CONCLUSIONS
  Adjuvant gemcitabine chemotherapy for BTC may be effective, particularly for patients with stage III and ICC.
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.forename: Masashi
authors.initials: M
authors.lastname: Kanai
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Masato
authors.initials: M
authors.lastname: Narita
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Nagata
authors.forename: Takamichi
authors.initials: T
authors.lastname: Ishii
authors.forename: Takahumi
authors.initials: T
authors.lastname: Machimoto
authors.forename: Kojiro
authors.initials: K
authors.lastname: Taura
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D001661:Biliary Tract Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine