title: Outcome of adjuvant therapy in biliary tract cancers.
abstract: OBJECTIVE
  There are high rates of recurrence after definitive surgery in biliary tract cancer patients. We reviewed the use and effectiveness of adjuvant therapy (AT; chemotherapy±radiotherapy) in a single institution series.
  
  
  METHODS
  Characteristics, treatment details, and follow-up data of all patients with biliary tract cancer who had definitive surgery from January 1987 to September 2011 were reviewed. The association between baseline variables and disease-free survival/overall survival (OS) were tested using Cox proportional hazard analysis in the univariable and multivariable settings.
  
  
  RESULTS
  Analysis included 296 patients (58% male; median age, 63 y). Negative or microscopically positive resections were reported in 42% and 14%, respectively, with 44% not reported. Node positivity was reported in 35% patients. AT was given in 28% of patients with 59% receiving chemotherapy and 35% concurrent chemotherapy/radiotherapy. Disease recurred in 60% patients. AT was associated with significantly improved OS (hazard ratio, 0.41; P=0.02). Compared with R0 resection, patients with R1 resection derived significantly increased benefit from AT (P for difference 0.02). In the node positive population (n=103), AT was associated with significantly improved OS (hazard ratio, 0.60; 95% confidence interval, 0.38-0.95; P=0.03).
  
  
  CONCLUSIONS
  Patients with R1 resection and node positive disease receiving AT after definitive surgery seem to derive OS advantage. Large prospective trials are needed to confirm these data.
authors.affiliation: Departments of *Medical Oncology ∥Palliative Care Medicine #Radiation Oncology, Princess Margaret Hospital Departments of §Surgery ¶Pathology, Toronto General Hospital, Toronto, ON, Canada †Department of Gastroenterology, Edouard Herriot Hospital, Lyon, France ‡Department of Medical Oncology, Waterford Regional Hospital, Waterford, Ireland.
authors.forename: Mairead G
authors.initials: MG
authors.lastname: McNamara
authors.forename: Thomas
authors.initials: T
authors.lastname: Walter
authors.forename: Anne M
authors.initials: AM
authors.lastname: Horgan
authors.forename: Eitan
authors.initials: E
authors.lastname: Amir
authors.forename: Sean
authors.initials: S
authors.lastname: Cleary
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: McKeever
authors.forename: Trisha
authors.initials: T
authors.lastname: Min
authors.forename: Elaine
authors.initials: E
authors.lastname: Wallace
authors.forename: David
authors.initials: D
authors.lastname: Hedley
authors.forename: Monika
authors.initials: M
authors.lastname: Krzyzanowska
authors.forename: Malcolm
authors.initials: M
authors.lastname: Moore
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Paul
authors.initials: P
authors.lastname: Greig
authors.forename: Stefano
authors.initials: S
authors.lastname: Serra
authors.forename: Laura A
authors.initials: LA
authors.lastname: Dawson
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001661:Biliary Tract Neoplasms / Q000473:pathology / Q000628:therapy*; D001662:Biliary Tract Surgical Procedures; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000473:pathology / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000628:therapy; D006500:Hepatic Duct, Common / Q000473:pathology; D006801:Humans; D018285:Klatskin Tumor / Q000473:pathology / Q000628:therapy; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents