R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer

Authors

  • Wolf-Rudiger Matull,

    1. UCL Institute of Hepatology, UCL Faculty of Biomedical Sciences, University College London (UCL), London, UK
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  • Dipok K. Dhar,

    1. UCL Institute of Hepatology, UCL Faculty of Biomedical Sciences, University College London (UCL), London, UK
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  • Lakshmana Ayaru,

    1. UCL Institute of Hepatology, UCL Faculty of Biomedical Sciences, University College London (UCL), London, UK
    2. Department of Gastroenterology, UCL Hospitals NHS Foundation Trust, London, UK
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  • Neomal S. Sandanayake,

    1. UCL Institute of Hepatology, UCL Faculty of Biomedical Sciences, University College London (UCL), London, UK
    2. Department of Gastroenterology, UCL Hospitals NHS Foundation Trust, London, UK
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  • Michael H. Chapman,

    1. UCL Institute of Hepatology, UCL Faculty of Biomedical Sciences, University College London (UCL), London, UK
    2. Department of Gastroenterology, UCL Hospitals NHS Foundation Trust, London, UK
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  • Aruna Dias,

    1. Department of Gastroenterology, UCL Hospitals NHS Foundation Trust, London, UK
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  • John Bridgewater,

    1. UCL Cancer Institute, UCL Faculty of Biomedical Sciences, University College London (UCL), London, UK
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  • George J. M. Webster,

    1. UCL Institute of Hepatology, UCL Faculty of Biomedical Sciences, University College London (UCL), London, UK
    2. Department of Gastroenterology, UCL Hospitals NHS Foundation Trust, London, UK
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  • Jin J. Bong,

    1. University Department of Surgery, Royal Free Hampstead NHS Trust and University College Medical School, London, UK
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  • Brian R. Davidson,

    1. University Department of Surgery, Royal Free Hampstead NHS Trust and University College Medical School, London, UK
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  • Stephen P. Pereira

    1. UCL Institute of Hepatology, UCL Faculty of Biomedical Sciences, University College London (UCL), London, UK
    2. Department of Gastroenterology, UCL Hospitals NHS Foundation Trust, London, UK
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Correspondence
Dr Stephen Pereira, UCL Institute of Hepatology, Royal Free Campus, University College London (UCL), London NW3, 2QG UK
Tel: +44 207 830 2333
Fax: +44 207 472 6225
e-mail: stephen.pereira@ucl.ac.uk

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.

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