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Liver Int ; 31(1): 99-107, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20846273

ABSTRACT

BACKGROUND: There is a need for better management strategies to improve the survival and quality of life in patients with biliary tract cancer (BTC). AIM: To assess prognostic factors for survival in a large, non-selective cohort of patients with BTC. METHOD: We compared outcomes in 321 patients with a final diagnosis of BTC (cholangiocarcinoma n = 237, gallbladder cancer n = 84) seen in a tertiary referral cancer centre between 1998 and 2007. Survival according to disease stage and treatment category was compared using log-rank testing. Cox's regression analysis was used to determine independent prognostic factors. RESULTS: Eighty-nine (28%) patients underwent a surgical intervention with curative intent, of whom 38% had R0 resections. Among the 321 patients, 34% were given chemo- and/or radiotherapy, 14% were palliated with photodynamic therapy (PDT) and 37% with biliary drainage procedures alone. The overall median survival was 9 months (3-year survival, 14%). R0-resective surgery conferred the most favourable outcome (3-year survival, 57%). Although patients palliated with PDT had more advanced clinical T-stages, their survival was similar to those treated with attempted curative surgery but who had positive resection margins. On multivariable analysis, treatment modality, serum carbohydrate-associated antigen 19-9, distant metastases and vascular involvement were independent prognostic indicators of survival. CONCLUSION: In this large UK series of BTC, palliative PDT resulted in survival similar to those with curatively intended R1/R2 resections. Surgery conferred a survival advantage only in patients with R0 resection margins, emphasising the need for accurate pre-operative staging.


Subject(s)
Bile Duct Neoplasms/drug therapy , Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic , Biliary Tract Surgical Procedures , Cholangiocarcinoma/drug therapy , Cholangiocarcinoma/surgery , Gallbladder Neoplasms/drug therapy , Gallbladder Neoplasms/surgery , Photochemotherapy , Adult , Aged , Aged, 80 and over , Bile Duct Neoplasms/mortality , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic/pathology , Chemotherapy, Adjuvant , Chi-Square Distribution , Cholangiocarcinoma/mortality , Cholangiocarcinoma/pathology , Drainage , Female , Gallbladder Neoplasms/mortality , Gallbladder Neoplasms/pathology , Humans , Kaplan-Meier Estimate , London , Male , Middle Aged , Palliative Care , Proportional Hazards Models , Radiotherapy, Adjuvant , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
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