Skip to main content
SpringerLink
Log in

Neither Neoadjuvant nor Adjuvant Therapy Increases Survival After Biliary Tract Cancer Resection with Wide Negative Margins

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

We investigated the role of neoadjuvant/adjuvant therapies on survival for resectable biliary tract cancer. We hypothesized that neoadjuvant and adjuvant therapy should improve the survival probability in these patients.

Methods

This was a retrospective review of a prospective database of patients resected for gallbladder cancer (GBC) and cholangiocarcinoma (CC). One hundred fifty-seven patients underwent resection for primary GBC (n = 63) and CC (n = 94). Fisher’s exact test, Student’s t test, the log-rank test, and a Cox proportional hazard model determined significant differences.

Results

The 5-year overall survival rate after resection of GBC and CC was 50.6 % and 30.4 %, respectively. Of the patients, 17.8 % received neoadjuvant chemotherapy, 48.7 % received adjuvant chemotherapy, while 15.8 % received adjuvant chemoradiotherapy. Patients with negative margins of at least 1 cm had a 5-year survival rate of 52.4 % (p < 0.01). Adjuvant therapy did not significantly prolong survival. Neoadjuvant therapy delayed surgical resection on average for 6.8 months (p < 0.0001). Immediate resection increased median survival from 42.3 to 53.5 months (p = 0.01).

Conclusions

Early surgical resection of biliary tract malignancies with 1 cm tumor-free margins provides the best probability for long-term survival. Currently available neoadjuvant or adjuvant therapy does not improve survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–1281.

    Article  PubMed  CAS  Google Scholar 

  2. Valle JW, Wasan H, Johnson P, Jones E, Dixon L, Swindell R, Baka S, Maraveyas A, Corrie P, Falk S, Gollins S, Lofts F, Evans L, Meyer T, Anthoney A, Iveson T, Highley M, Osborne R, Bridgewater J. Gemcitabine alone or in combination with cisplatin in patients with advanced or metastatic cholangiocarcinomas or other biliary tract tumours: a multicentre randomised phase II study—The UK ABC-01 Study. Br J Cancer. 2009;101(4):621–627.

    Article  PubMed  CAS  Google Scholar 

  3. Eckel F, Schmid RM. Chemotherapy in advanced biliary tract carcinoma: a pooled analysis of clinical trials. Br J Cancer. 2007;96(6):896–902.

    Article  PubMed  CAS  Google Scholar 

  4. Nelson JW, Ghafoori AP, Willett CG, Tyler DS, Pappas TN, Clary BM, Hurwitz HI, Bendell JC, Morse MA, Clough RW, Czito BG. Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma. Int J Radiat Oncol Biol Phys. 2009;73(1):148–153.

    Article  PubMed  CAS  Google Scholar 

  5. Nathan H, Pawlik TM, Wolfgang CL, Choti MA, Cameron JL, Schulick RD. Trends in survival after surgery for cholangiocarcinoma: a 30-year population-based SEER database analysis. J Gastrointest Surg. 2007;11(11):1488–1496; discussion 1496–1487.

    Article  PubMed  Google Scholar 

  6. Murakami Y, Uemura K, Hayasidani Y, Sudo T, Hashimoto Y, Ohge H, Sueda T. Indication for postoperative adjuvant therapy in biliary carcinoma based on analysis of recurrence and survival after surgical resection. Dig Dis Sci. 2009;54(6):1360–1364.

    Article  PubMed  CAS  Google Scholar 

  7. Eckel F, Jelic S. Biliary cancer: ESMO clinical recommendation for diagnosis, treatment and follow-up. Ann Oncol. 2009;20 Suppl 4:46–48.

    PubMed  Google Scholar 

  8. Wolpin BM, Mayer RJ. A step forward in the treatment of advanced biliary tract cancer. N Engl J Med. 2010;362(14):1335–1337.

    Article  PubMed  CAS  Google Scholar 

  9. Seehofer D, Thelen A, Neumann UP, Veltzke-Schlieker W, Denecke T, Kamphues C, Pratschke J, Jonas S, Neuhaus P. Extended bile duct resection and [corrected] liver and transplantation in patients with hilar cholangiocarcinoma: long-term results. Liver Transpl. 2009;15(11):1499–1507.

    Article  PubMed  Google Scholar 

  10. Hernandez J, Cowgill SM, Al-Saadi S, Villadolid D, Ross S, Kraemer E, Shapiro M, Mullinax J, Cooper J, Goldin S, Zervos E, Rosemurgy A. An aggressive approach to extrahepatic cholangiocarcinomas is warranted: margin status does not impact survival after resection. Ann Surg Oncol. 2008;15(3):807–814.

    Article  PubMed  Google Scholar 

  11. Murakami Y, Uemura K, Hayashidani Y, Sudo T, Hashimoto Y, Ohge H, Sueda T. Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma. J Surg Oncol. 2007;95(3):207–212.

    Article  PubMed  Google Scholar 

  12. Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer. 2002;95(8):1685–1695.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research is supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support grant CA016672 and partially funded by an NIH T32 training grant CA09599 (ESG). The authors extend our appreciation to Kristine Ash and Vickie Ellis for administrative support on this project.

Conflict of interest

The authors declare that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler Street, Unit 1484, Houston, TX, 77030, USA

    Evan S. Glazer, Eddie K. Abdalla, Jean-Nicolas Vauthey & Steven A. Curley

  2. Department of Surgery, The University of Arizona, Tucson, AZ, USA

    Evan S. Glazer

  3. Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Ping Liu

  4. Department of Mechanical Engineering and Materials Science, Rice University, Houston, TX, USA

    Steven A. Curley

Authors
  1. Evan S. Glazer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ping Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eddie K. Abdalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-Nicolas Vauthey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven A. Curley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven A. Curley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Glazer, E.S., Liu, P., Abdalla, E.K. et al. Neither Neoadjuvant nor Adjuvant Therapy Increases Survival After Biliary Tract Cancer Resection with Wide Negative Margins. J Gastrointest Surg 16, 1666–1671 (2012). https://doi.org/10.1007/s11605-012-1935-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-012-1935-1

Keywords

Search

Navigation