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Identification of Patients for Adjuvant Therapy After Resection of Carcinoma of the Extrahepatic Bile Ducts: A Propensity Score-Matched Analysis

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Resectability rates for extrahepatic cholangiocarcinoma have increased over time, but long-term survival after resection alone with curative intent remains poor. Recent series suggest improved survival with adjuvant therapy. Patient subsets benefiting most from adjuvant therapy have not been clearly defined.

Methods

Patients with extrahepatic cholangiocarcinoma who underwent resection with curative intent and received adjuvant therapy (chemotherapy ± radiotherapy) or surgery alone (SA) were identified in the U.S. National Cancer Data Base (2004–2014). Cox regression identified covariates associated with overall survival (OS). Adjuvant therapy and SA cohorts were matched (1:1) by propensity scores based on the survival hazard in Cox modeling. Overall survival was compared by Kaplan–Meier estimates.

Results

Of 4872 patients, adjuvant chemotherapy was used frequently for 2416 (49.6%), often in conjunction with radiotherapy (RT) (n = 1555, 64.4%). Adjuvant chemotherapy with or without RT was used increasingly for cases with higher T classification [reference: T1–2; T3: 1.36; 95% confidence interval (CI), 1.19–1.55; T4: 1.77; 95% CI 1.38–2.26], nodal positivity [odds ratio (OR), 1.26; 95% CI 1.01–1.56], lymphovascular invasion (OR 1.21; 95% CI 1.01–1.46), or margin-positive resection (OR 1.85; 95% CI 1.61–2.12), and was associated with significant improvements in OS for each high-risk subset in the propensity score-matched cohort. Adjuvant therapy was associated with improved median OS for hilar tumors (40.0 vs 30.6 months; p = 0.025) but not distal tumors (33.0 vs 30.3 months; p = 0.123). Chemoradiotherapy was associated with superior outcomes compared with chemotherapy alone in the subset of margin-positive resection [hazard ratio (HR), 0.63; 95% CI 0.42–0.94].

Conclusions

Adjuvant multimodality therapy is associated with improved survival for patients with resected extrahepatic cholangiocarcinoma and high-risk features.

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Acknowledgment

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used in this report. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Disclosure

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Brett L. Ecker MD, Charles C. Vining MD, Robert E. Roses MD, Laura Maggino MD, Major K. Lee MD, PhD, Douglas L. Fraker MD, Charles M. Vollmer Jr. MD & Jashodeep Datta MD

  2. Department of Surgery, Pancreas Institute, University of Verona, Verona, Italy

    Laura Maggino MD

  3. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Jeffrey A. Drebin MD, PhD & Jashodeep Datta MD

Authors
  1. Brett L. Ecker MD
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  2. Charles C. Vining MD
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  3. Robert E. Roses MD
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  4. Laura Maggino MD
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  5. Major K. Lee MD, PhD
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  6. Jeffrey A. Drebin MD, PhD
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  7. Douglas L. Fraker MD
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  8. Charles M. Vollmer Jr. MD
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  9. Jashodeep Datta MD
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Contributions

Conception and design (BLE, JD), acquisition of data (BLE, CMV), or analysis and interpretation of data (BLE, CCV, RER, LM, MKL, JAD, DLF, CMV, JD); drafting (BLE, CMV, JD) or revising (BLE, CCV, RER, LM, MKL, JAD, DLF, CMV, JD) (3) final approval of the version to be published (BLE, CCV, RER, LM, MKL, JAD, DLF, CMV, JD).

Corresponding author

Correspondence to Jashodeep Datta MD.

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Ecker, B.L., Vining, C.C., Roses, R.E. et al. Identification of Patients for Adjuvant Therapy After Resection of Carcinoma of the Extrahepatic Bile Ducts: A Propensity Score-Matched Analysis. Ann Surg Oncol 24, 3926–3933 (2017). https://doi.org/10.1245/s10434-017-6095-9

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  • DOI: https://doi.org/10.1245/s10434-017-6095-9

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