Failure to administer multimodality therapy leads to sub-optimal outcomes for patients with node-positive biliary tract cancers in the United States.

Autor: Sheka AC; Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Altman A; Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Marmor S; Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Hui JYC; Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Denbo JW; Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA., Ankeny JS; Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Jensen EH; Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA. Electronic address: jense893@umn.edu.
Jazyk: angličtina
Zdroj: Surgical oncology [Surg Oncol] 2020 Sep; Vol. 34, pp. 298-303. Date of Electronic Publication: 2020 Jun 30.
DOI: 10.1016/j.suronc.2020.06.004
Abstrakt: Background: Lymph node-positive biliary tract cancers have poor overall survival. Surgical resection followed by systemic chemotherapy is the mainstay of treatment. We sought to assess the delivery of multimodality therapy in the United States.
Methods: The Surveillance, Epidemiology, and End Results program database was used to identify patients with node-positive biliary tract cancers without distant metastases from 2000 to 2014. Patients were stratified by disease subtype (gallbladder cancer, intrahepatic, extrahepatic, or hilar cholangiocarcinoma) and treatment received (surgery alone, chemotherapy alone, or surgery + chemotherapy). Survival was analyzed using the Kaplan-Meier method and Cox proportional hazard modeling.
Results: A total of 3226 patients with node-positive biliary tract cancers were identified. Of 2837 patients who underwent surgical resection, 1386 (49%) received no systemic chemotherapy following surgery, while 1451 (51%) received surgery + chemotherapy. A total of 389 patients (12%) received chemotherapy alone. Median overall survival was longer for patients who underwent surgery + chemotherapy (19 months, p < 0.0001). There was no difference in survival for those who received surgery alone versus chemotherapy alone (10 months for both, p = NS). Receipt of surgery + chemotherapy was independently associated with survival on Cox proportional hazard ratio modeling compared to surgery alone (HR for mortality 1.71, 95% CI 1.56-1.87, p < 0.0001) or chemotherapy alone (HR 1.68, 95% CI 1.46-1.92, p < 0.0001). These trends were consistent across all disease subtypes.
Discussion: Optimal survival for node-positive biliary tract cancers depends on multimodality therapy. Following surgery, a substantial proportion of patients do not receive guideline recommended adjuvant therapy.
(Copyright © 2020. Published by Elsevier Ltd.)
Databáze: MEDLINE
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