title: Defining the Chance of Statistical Cure Among Patients with Extrahepatic Biliary Tract Cancer.
abstract: While surgery offers the best curative-intent treatment, many patients with biliary tract malignancies have poor long-term outcomes. We sought to apply a non-mixture cure model to calculate the cure fraction and the time to cure after surgery of patients with peri-hilar cholangiocarcinoma (PHCC) or gallbladder cancer (GBC).
  
  
  
  Using the Extrahepatic Biliary Malignancy Consortium, 576 patients who underwent curative-intent surgery for gallbladder carcinoma or peri-hilar cholangiocarcinoma between 1998 and 2014 at 10 major hepatobiliary institutions were identified and included in the analysis. A non-mixture cure model was adopted to compare mortality after surgery to the mortality expected for the general population matched by sex and age.
  
  
  
  The median and 5-year overall survival (OS) were 1.9 years (IQR, 0.9-4.9) and 23.9 % (95 % CI, 19.6-28.6). Among all patients with PHCC or GBC, the probability of being cured after surgery was 14.5 % (95 % CI, 8.7-23.2); the time to cure was 9.7 years and the median survival of uncured patients was 1.8 years. Determinants of cure probabilities included lymph node metastasis and CA 19.9 level (p ≤ 0.05). The cure fraction for patients with a CA 19.9 < 50 U/ml and no lymph nodes metastases were 39.0 % versus only 5.1 % among patients with a CA 19.9 ≥ 50 who also had lymph node metastasis.
  
  
  
  Examining an "all comer" cohort, <15 % of patients with PHCC or GBC could be considered cured after surgery. Factors such CA 19.9 level and lymph node metastasis independently predicted long-term outcome. Estimating the odds of statistical cure following surgery for biliary tract cancer can assist in decision-making as well as inform discussions around survivorship.
authors.affiliation: Professor and Chair Department of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: Professor and Chair Department of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bagante
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Cecilia G
authors.initials: CG
authors.lastname: Ethun
authors.affiliation: Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Poultsides
authors.affiliation: Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Thuy
authors.initials: T
authors.lastname: Tran
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Idrees
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Chelsea A
authors.initials: CA
authors.lastname: Isom
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Krasnick
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Winslow
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Clifford
authors.initials: C
authors.lastname: Cho
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.affiliation: Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.affiliation: Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
authors.forename: Harveshp D
authors.initials: HD
authors.lastname: Mogal
authors.affiliation: Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
authors.forename: Eliza
authors.initials: E
authors.lastname: Beal
authors.affiliation: Department of Surgery, New York University, New York, NY, USA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Hatzaras
authors.affiliation: Department of Surgery, New York University, New York, NY, USA.
authors.forename: Rivfka
authors.initials: R
authors.lastname: Shenoy
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Professor and Chair Department of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA. tim.pawlik@osumc.edu.|Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. tim.pawlik@osumc.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000473:pathology* / Q000601:surgery; D018395:CA-19-9 Antigen / Q000097:blood; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality* / Q000601:surgery; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical
chemical_list: D018395:CA-19-9 Antigen