Surgery Alone Versus Surgery Followed by Chemotherapy and Radiotherapy in Resected Extrahepatic Bile Duct Cancer: Treatment Outcome Analysis of 336 Patients.
OBJECTIVE
This study analyzed the outcomes of patients with resected extrahepatic bile duct cancer (EHBDC) in order to clarify the role of adjuvant treatments in these patients.


METHODS
A total of 336 patients with EHBDC who underwent curative resection between 2001 and 2010 were analyzed retrospectively. The treatment types were as follows: surgery alone (n=168), surgery with chemotherapy (CTx, n=90), surgery with radiotherapy (RT) alone (n=29), and surgery with chemoradiotherapy (CRT, n=49).


RESULTS
The median follow-up period was 63 months. The 5-year rates of locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) for all patients were 56.5%, 59.7%, 36.6%, and 42.0%, respectively. In multivariate analysis, surgery with RT and CRT was a significant prognostic factor for LRFFS, and surgery with CTx was a significant prognostic factor for DMFS, and surgery with CTx, RT, and CRT was a significant prognostic factor for PFS (p < 0.05). Surgery with CTx and CRT showed association with superior OS (p < 0.05), and surgery with RT had marginal significance (p=0.078). In multivariate analysis of the R1 resection patients, surgery with CRT showed significant association with OS (p < 0.05).


CONCLUSIONS
Adjuvant RT and CTx may be helpful in improving clinical outcomes of patients with resected EHBDC who have a high risk of disease recurrence, particularly R1 resection patients. Conduct of additional prospective, larger-scale studies will be required in order to confirm the benefit of adjuvant RT and CTx in these patients.
Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Jung Ho
JH
Im
Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Jinsil
J
Seong
Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Ik Jae
IJ
Lee
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Joon Seong
JS
Park
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Dong Sup
DS
Yoon
Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Kyung Sik
KS
Kim
Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Woo Jung
WJ
Lee
Department of Radiation Oncology, Ewha Womans University Medical Center, Seoul, Korea.
Kyung Ran
KR
Park
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017734:Bile Ducts, Extrahepatic / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects / Q000601:surgery*; D001661:Biliary Tract Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
Adjuvant radiotherapy; Biliary tract neoplasms; Cholangiocarcinoma; Drug therapy; Extrahepatic bile duct cancer; Survival