title: Natural history of metastatic biliary tract cancer (BTC) patients with good performance status (PS) who were treated with only best supportive care (BSC).
abstract: BACKGROUND
  Although chemotherapy is widely recommended for patients with metastatic biliary tract cancer, the natural course of these patients, especially those with good performance status who are indicated for chemotherapy, is not known.
  
  
  METHODS
  We retrospectively reviewed patients with metastatic or locally advanced biliary cancer who were diagnosed at six cancer centers. Patients were eligible if they had good performance (ECOG 0-2) and no history of any treatment for cancer. The primary objective was to evaluate the survival time of patients with advanced biliary cancer with good performance who were untreated.
  
  
  RESULTS
  Of the 1677 patients, 204 met the inclusion criteria. The median age and overall survival were 72.0 years and 7.1 months. Overall survival (months) by location was 4.7 for intrahepatic, 9.7 for extrahepatic, 4.4 for gallbladder and 11.2 for ampulla of vater cancer. In subgroup analysis, overall survival of locally advanced biliary cancer was 13.8 months and that of patients with normal carcinoembryonic antigen/carbohydrate antigen 19-9 was 10.6 months. In multivariate analysis, variables that were associated with poor prognosis were metastatic biliary cancer [hazard ratio 2.19 (P = 0.001)], high baseline carcinoembryonic antigen level (defined as >4.0 ng/ml) [hazard ratio 1.51 (P = 0.024)] and high baseline carbohydrate antigen 19-9 level (defined as >100 U/ml) [hazard ratio 1.93 (P = 0.001)].
  
  
  CONCLUSIONS
  Advanced biliary tract cancer with good performance status showed modest survival without any treatment. Furthermore, subgroup analysis showed that patients with normal carbohydrate antigen 19-9 or carcinoembryonic antigen level or locally advanced status had favorable survival. Further studies comparing the outcome of chemotherapy with that of best supportive care in patients with unresectable biliary tract cancer are warranted.
authors: Division of Hematology and Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon.
authors: Jun Ho
authors: JH
authors: Ji
authors: Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju.
authors: Haa-Na
authors: HN
authors: Song
authors: Dong-A University Department of Preventive Medicine, School of Medicine, Busan.
authors: Rock Bum
authors: RB
authors: Kim
authors: Department of Internal Medicine, Dong-A University College of Medicine, Busan.
authors: Sung Yong
authors: SY
authors: Oh
authors: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Ho Yeong
authors: HY
authors: Lim
authors: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Joon Oh
authors: JO
authors: Park
authors: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Se Hoon
authors: SH
authors: Park
authors: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Moon Jin
authors: MJ
authors: Kim
authors: Department of Internal Medicine, Dankook University College of Medicine, Cheonan.
authors: Soon Il
authors: SI
authors: Lee
authors: Department of Internal Medicine, Dankook University College of Medicine, Cheonan.
authors: Sung Hyeok
authors: SH
authors: Ryou
authors: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul.
authors: In Gyu
authors: IG
authors: Hwang
authors: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul.
authors: Joung-Soon
authors: JS
authors: Jang
authors: Department of Internal Medicine, Institute of Health Science, School of Medicine, Gyeongsang National University, Jinju.
authors: Hong Jun
authors: HJ
authors: Kim
authors: Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea.
authors: Jun Young
authors: JY
authors: Choi
authors: Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju newatp@naver.com.
authors: Jung-Hun
authors: JH
authors: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D001650:Bile Duct Neoplasms / Q000401:mortality*; D017734:Bile Ducts, Extrahepatic; D001653:Bile Ducts, Intrahepatic; D018395:CA-19-9 Antigen / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D018281:Cholangiocarcinoma / Q000401:mortality*; D003138:Common Bile Duct Neoplasms / Q000401:mortality; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D057832:Watchful Waiting / Q000379:methods
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen
keywords: best supportive care; biliary tract cancer; natural history