Do patients with recurrent and de novo metastatic biliary cancer have similar outcomes on treatment?

Abstract

Background: Biliary tract cancers (BTCs) include cholangiocarcinoma, referring to cancers arising in the intrahepatic, perihilar or distal biliary tree, ampulla of vater and gallbladder carcinoma. Even after complete surgical resection, a large number of patients with BTC develop recurrence. Whether recurrence after surgery and de novo metastatic BTC should have comparable stratification in first-line palliative systemic therapy studies is unknown. Methods: Patients who received palliative chemotherapy as first-line treatment for advanced BTC between January 1987 and May 2014 in Princess Margaret Cancer Centre, Toronto were reviewed. Probability of overall survival (OS) was estimated using the Kaplan- Meier method, and independent prognostic factors for OS were identified using the multivariable Cox-proportional hazard model. Results: There were 171 patients with recurrent and 309 with de novo metastatic disease. Median age at diagnosis was 62 years; performance status<2: 436 (91%) patients, male: 262 (55%). In the recurrent group, 102 (60%) had indwelling stents, 33 (32%) ampulla of vater, 14 (14%) gallbladder, 55 (54%) cholangiocarcinoma. In the de novo metastatic group, 173 (56%) had indwelling stents, primary site was ampulla of vater in 13 (7%), gallbladder in 43 (25%), cholangiocarcinoma in 117 (68%). Systemic treatment received was gemcitabine/platinum doublet in 137 (29%), gemcitabine/5- fluorouracil doublet; 186 (39%), gemcitabine; 93 (19%), other; 64 (13%). Median OS for the recurrent group who received firstline palliative chemotherapy was 15.6 months (95%-confidence interval [CI] 13.5-18.0) and 14.4 months (95%-CI 12.0-16.0) in the de novo metastatic group. Multivariable analysis for OS revealed that gallbladder as the primary site (P=0.04) and ECOG performance status ≥ 2 (P=0.001) were prognostic for worse OS. De novo metastatic status was not prognostic for worse OS compared with recurrent status (Hazard ratio 0.9, 95% CI-0.66-1.23, P=0.51). Conclusions: Similar treatment of patients with recurrent disease after surgery and de novo metastatic BTC, with first-line palliative chemotherapy is acceptable.