Abstract
Introduction
The optimal treatment for unresected nonmetastatic biliary tract cancer (uBTC) is
not well-established. The objective of this study was to analyze the treatment patterns
and compare the differences in overall survival (OS) between different treatment strategies
amongst older adults with uBTC.
Materials and methods
We identified patients aged ≥65 years with uBTC using the Surveillance, Epidemiology,
and End Results (SEER)-Medicare database (2004–2015). Treatments were classified into
chemotherapy, chemoradiotherapy, and radiotherapy. The primary outcome was OS. The
differences in OS were analyzed using Kaplan-Meier curves and multivariable Cox proportional
hazard regression.
Results
A total of 4352 patients with uBTC were included. The median age was 80 years and
median OS was 4.1 months. Most patients (67.3%, n = 2931) received no treatment, 19.1% chemotherapy (n = 833), 8.1% chemoradiotherapy (n = 354), and 5.4% radiotherapy alone (n = 234). Patients receiving no treatment were older and had more comorbidities. Chemotherapy
was associated with significantly longer OS than no treatment in uBTC (hazard ratio
[HR] 0.87, 95% confidence interval [CI] 0.79–0.95), but no difference was found in
the subgroups of intrahepatic cholangiocarcinoma (iCCA; HR 0.87, 95% CI 0.75–1.00)
and gallbladder carcinoma (GBC; HR 1.09, 95% CI 0.86–1.39). In the sensitivity analyses,
capecitabine-based chemoradiotherapy showed significantly longer OS in uBTC compared
to chemotherapy (adjusted HR 0.71, 95% CI 0.53–0.95).
Discussion
A minority of older patients with uBTC receive systemic treatments. Chemotherapy was
associated with longer OS compared to no treatment in uBTC, but not in the subgroups
of iCCA and GBC. The efficacy of chemoradiotherapy, especially in perihilar cholangiocarcinoma
using capecitabine-based chemoradiotherapy, may be further evaluated in prospective
clinical trials.
Keywords
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References
- Biliary tract cancer incidence and trends in the United States by demographic group, 1999-2013.Cancer. 2019; 125: 1489-1498
- Biliary cancer: Esmo clinical practice guidelines for diagnosis, treatment and follow-up†.Ann Oncol. 2016; 27: v28-v37
- Increased incidence but improved median overall survival for biliary tract cancers diagnosed in Ontario from 1994 through 2012: a population-based study.Cancer. 2016; 122: 2534-2543
- Adjuvant therapy for resected biliary tract cancer: Asco clinical practice guideline.J Clin Oncol. 2019; 37: 1015-1027
- Survival rates are higher in married patients with biliary tract cancer: a population-based study.Oncotarget. 2018; 9: 9531-9539
- Survival rates for bile duct cancer.2022 (Available at) (Accessed on august 23th, 2019)
- Survival rates for gallbladder cancer.2022 (Available at) (Accessed on august 23th, 2019)
- Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer.N Engl J Med. 2010; 362: 1273-1281
- Gemcitabine plus cisplatin versus chemoradiotherapy in locally advanced biliary tract cancer: federation francophone de cancerologie digestive 9902 phase ii randomised study.Eur J Cancer. 2014; 50: 2975-2982
- Nccn clinical practice guidelines in oncology, hepatobiliary cancers, versie 3, laatste update: August 1, 2019.2022 (Available at) (Accessed on september 23th, 2019)
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- Efficacy and safety of folfirinox as salvage treatment in advanced biliary tract cancer: an open-label, single arm, phase 2 trial.Br J Cancer. 2020; 122: 634-639
- Treatment and survival of resected and unresected distal cholangiocarcinoma: a nationwide study.Acta Oncol. 2019; 58: 1048-1055
- Trends in treatment and survival of gallbladder cancer in the Netherlands; identifying gaps and opportunities from a nation-wide cohort.Cancers (Basel). 2020; : 12
- Describing treatment patterns for elderly patients with intrahepatic cholangiocarcinoma and predicting prognosis by a validated model: a population-based study.J Cancer. 2021; 12: 3114-3125
- Best supportive care compared with chemotherapy for unresectable gall bladder cancer: a randomized controlled study.J Clin Oncol. 2010; 28: 4581-4586
- Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer.Ann Oncol. 1996; 7: 593-600
- Chemotherapy versus best supportive care in advanced biliary tract carcinoma: a multi-institutional propensity score matching analysis.Cancer Res Treat. 2018; 50: 791-800
- New horizons for precision medicine in biliary tract cancers.Cancer Discov. 2017; 7: 943-962
- Capecitabine plus oxaliplatin as first-line treatment in patients with advanced biliary system adenocarcinoma: a prospective multicentre phase ii trial.Br J Cancer. 2008; 98: 309-315
- Intrahepatic cholangiocarcinoma: socioeconomic discrepancies, contemporary treatment approaches and survival trends from the national cancer database.Ann Surg Oncol. 2019; 26: 1993-2000
- Radioembolization plus chemotherapy for first-line treatment of locally advanced intrahepatic cholangiocarcinoma: a phase 2 clinical trial.JAMA Oncol. 2019; 6: 51-59
- Assessment of hepatic arterial infusion of floxuridine in combination with systemic gemcitabine and oxaliplatin in patients with unresectable intrahepatic cholangiocarcinoma: a phase 2 clinical trial.JAMA Oncol. 2020; 6: 60-67
- Efficacy and safety of systemic induction therapy in initially unresectable locally advanced intrahepatic and perihilar cholangiocarcinoma: a systematic review.Cancer Treat Rev. 2020; 91102110
- Treatment selection and survival outcomes with and without radiation for unresectable, localized intrahepatic cholangiocarcinoma.Cancer J. 2016; 22: 237-242
- Chemoradiation therapy for unresected extrahepatic cholangiocarcinoma: a propensity score-matched analysis.Ann Surg Oncol. 2017; 24: 4001-4008
- Swog s0809: a phase ii intergroup trial of adjuvant capecitabine and gemcitabine followed by radiotherapy and concurrent capecitabine in extrahepatic cholangiocarcinoma and gallbladder carcinoma.J Clin Oncol. 2015; 33: 2617-2622
- Protocol for a phase iii randomized trial of chemoradiation and systemic chemotherapy vs. systemic chemotherapy alone in patients with unresectable nonmetastatic cholangiocarcinoma.Int J Clin Trials. 2017; 4: 14-19
- Challenges of guarantee-time bias.J Clin Oncol. 2013; 31: 2963-2969
Article info
Publication history
Published online: February 25, 2023
Accepted:
February 6,
2023
Received in revised form:
January 31,
2023
Received:
March 23,
2022
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