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

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.

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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.

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Correspondence to Steven A. Curley.

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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

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

Keywords

  • Cholangiocarcinoma
  • Resection
  • Neoadjuvant
  • Adjuvant