R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer - PubMed (original) (raw)
Comparative Study
R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer
Wolf-Rudiger Matull et al. Liver Int. 2011 Jan.
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.
© 2010 John Wiley & Sons A/S.
Figures
Figure 1
Management algorithm for 321 patients with biliary tract cancer (BTC). R0, curative resection; R1, microscopic infiltration of the resection margins; R2, evidence of macroscopic residual disease.
Figure 2
Kaplan-Meier survival estimates of patients in the four treatment groups. Individual patients still alive during the follow-up period are indicated by marks on the curves. The median survival time difference between the four treatment groups was statistically significant (p<0.001). Comparing the treatment groups’ survival times individually, the significance levels were as follows: curatively intended surgery vs. photodynamic therapy (PDT), p=0.012; surgery vs. chemo- and/or radiotherapy, p<0.001; surgery vs. biliary drainage procedure, p<0.001; PDT vs. chemo- and/or radiotherapy, p=0.06; PDT vs. biliary drainage procedure, p=0.019; chemo- and/or radiotherapy vs. biliary drainage procedure, p=0.136.
Figure 3
Kaplan-Meier survival estimates comparing patients with curatively intended surgeries (with R0 and R1/R2 outcome) with patients receiving photodynamic therapy (PDT). Survival times differed significantly between R0 resection and PDT (p<0.001), as well as R0 and R1/2 resections (p<0.001), but there was no difference between PDT and R1/2 resections (p=0.52).
References
- Neuhaus P, Jonas S, Settmacher U, Thelen A, Benckert C, Lopez-Hänninen E, et al. Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality. Langenbecks Arch Surg. 2003;388:194–200. - PubMed
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