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Trends in Receipt of Adjuvant Chemotherapy and its Impact on Survival in Resected Biliary Tract Cancers

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Resection remains the cornerstone of curative-intent treatment for biliary tract cancers (BTCs). However, recent randomized data also support a role for adjuvant chemotherapy (AC). This study aimed to characterize trends in the use of AC and subsequent outcomes in gallbladder cancer and cholangiocarcinoma (CCA).

Methods

The National Cancer Database (NCDB) was queried for patients with resected, localized BTC from 2010 to 2018. Trends in AC were compared among BTC subtypes and stages of disease. Multivariable logistic regression was used to identify factors associated with receipt of AC. Survival analysis was performed with Kaplan-Meier and multivariable Cox proportional hazards methods.

Results

The study identified 7039 patients: 4657 (66%) with gallbladder cancer, 1159 (17%) with intrahepatic CCA (iCCA), and 1223 (17%) with extrahepatic CCA (eCCA). Adjuvant chemotherapy was administered to 2172 (31%) patients, increasing from 23% in 2010 to 41% in 2018. Factors associated with AC included female sex, year of diagnosis, private insurance, care at an academic center, higher education, eCCA (vs iCCA), positive margins, and stage II or III disease (vs stage I). Alternatively, increasing age, higher comorbidity score, gallbladder cancer (vs iCCA), and farther travel distance for treatment were associated with reduced odds of AC. Overall, AC was not associated with a survival advantage. However, subgroup analysis showed that AC was associated with a significant reduction in mortality among patients with eCCA.

Conclusions

Among the patients with resected BTC, those who received AC were in the minority. In the context of recent randomized data and evolving recommendations, emphasis on guideline concordance with a focus on at-risk populations may improve outcomes.

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Acknowledgment

The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC’s NCDB are the source of the de-identified data used in this study. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Kristen E. Rhodin MD, Annie Liu MD, PhD, Alex Bartholomew MD, Anika Parameswaran, Kevin N. Shah MD, Garth Herbert MD, Sabino Zani MD, Daniel P. Nussbaum MD, Peter J. Allen MD & Michael E. Lidsky MD

  2. Duke University School of Medicine, Durham, NC, USA

    Ryan Kramer BA

  3. Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Hope Uronis MD, John Strickler MD, David Hsu MD, PhD & Michael A. Morse MD

  4. Duke Cancer Institute, Durham, NC, USA

    Hope Uronis MD, John Strickler MD, David Hsu MD, PhD, Michael A. Morse MD, Sabino Zani MD, Daniel P. Nussbaum MD, Peter J. Allen MD & Michael E. Lidsky MD

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  1. Kristen E. Rhodin MD
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Corresponding author

Correspondence to Kristen E. Rhodin MD.

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Disclosure

K. Rhodin is supported by NIH 1R38AI140297. A. Liu is supported by NIH F32CA268527. K. Rhodin and A. Liu both acknowledge support from the Duke Cancer Institute as part of the P30 Cancer Center Support Grant (grant ID: P30 CA014236). M. Lidsky receives funding support from the Department of Surgery and Duke Cancer Institute, the Duke School of Medicine Strong Start Award, The American College of Surgeons National Surgeon Scientist Program, and the Cholangiocarcinoma Foundation Research Fellowship Award. This project also was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant KL2 TR002554 (M. Lidsky). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. J. Strickler declares Abbvie: consulting (self); research grant (institution). Amgen: consulting (self); research grant (institution). AstraZeneca: consulting (self); research grant (institution). Beigene: consulting (self); research grant (institution). Daiichi-Sankyo: consulting (self); research grant (institution). Eli Lilly: consulting (self); research grant (institution). GSK: consulting (self); research grant (institution). Natera: consulting (self). Pfizer: consulting (self). Roche/Genentech: consulting (self); research grant (institution). Seagen: consulting (self); research grant (institution). Takeda: consulting (self). Viatris: consulting (self). Silverback Therapeutics: consulting (self); research grant (institution). Astar D3: research grant (institution). Bayer: consulting (self); research grant (institution). Curegenix: research grant (institution). Gossamer Bio: research grant (institution). Leap Therapeutics: research grant (institution). Nektar: research grant (institution). Sanofi: research grant (institution).

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Oral Presentation at the Americas Hepato-Pancreato-Biliary Association Annual Meeting, March 10, 2023, Miami, FL.

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Rhodin, K.E., Liu, A., Bartholomew, A. et al. Trends in Receipt of Adjuvant Chemotherapy and its Impact on Survival in Resected Biliary Tract Cancers. Ann Surg Oncol 30, 4813–4821 (2023). https://doi.org/10.1245/s10434-023-13567-4

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