title: Adjuvant Chemotherapy and Radiation Therapy is Associated with Improved Survival for Patients with Extrahepatic Cholangiocarcinoma.
abstract: BACKGROUND
  This study aimed to analyze adjuvant therapy among patients with extrahepatic cholangiocarcinoma (EHC) at a national level.
  
  
  METHODS
  The American College of Surgeons National Cancer Data Base was used to identify patients with resected EHC (pathologic stages 1-3) between 1998 and 2006 (n = 8741). Three groups were compared: surgery only (S, n = 5766), surgery plus adjuvant chemotherapy (AC, n = 450), and surgery plus adjuvant chemotherapy and radiation therapy (ACR, n = 1918). The study investigated how patient demographics, provider characteristics, and tumor-specific variables were associated with receipt of adjuvant therapy and overall survival.
  
  
  RESULTS
  Patients who received adjuvant treatment were more likely to be younger (median age S, 70 years; AC, 65 years; ACR, 63 years), in the highest income quartile (>$46,000: S, 38.3 %; AC, 43.4 %; ACR, 44.7 %), and treated at a community cancer center (S, 43.0 %; AC, 50.7 %; ACR, 52.9 %) (all p < 0.001). These patients also were more likely to have positive lymph nodes (S, 34.7 %; AC, 69.6 %; ACR, 63.3 %), positive surgical margins (S, 5.9 %; AC, 7.1 %; ACR, 10.7 %), and stage 3 disease (S, 21.4 %; AC, 37.8 %; ACR, 37.9 %) (all p < 0.001). Multivariate analysis of the entire cohort showed improved survival with ACR (hazard ratio [HR] 0.82; 95 % confidence interval [CI] 0.75-0.91). The survival benefit was independent of margin status (R0: HR 0.88; 95 % CI 0.79-0.97; R1: HR 0.49; 95 % CI 0.38-0.62).
  
  
  CONCLUSIONS
  This national analysis suggests that ACR are associated with improved survival for high-risk EHC patients, such as those with positive lymph nodes. Until randomized clinical trials are conducted, these may be the best available data to guide adjuvant therapy for resected EHC.
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA. rshoehn@gmail.com.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Ertel
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Meier
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA. abbottdl@ucmail.uc.edu.|Division of Surgical Oncology, University of Cincinnati School of Medicine, Cincinnati, OH, USA. abbottdl@ucmail.uc.edu.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D017734:Bile Ducts, Extrahepatic / Q000473:pathology*; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality*; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate