Abstract
4109 Background: Biliary tract cancers (BTCs) encompass both cholangiocarcinoma (CC), arising in intrahepatic, perihilar (klatskin), or distal biliary tree, ampulla of vater and gallbladder carcinoma (GBC). Prognosis is poor for majority of these patients (pts). Aim: To retrospectively review outcomes of pts, as practices/treatments evolve, who presented to a multidisciplinary team at tertiary referral center Princess Margaret Hospital, Toronto, with a diagnosis of BTC. Methods: 1057 pts were followed from 01/87 - 09/11. Complete demographics, performance status (PS), disease site, histological diagnosis, percentage receiving surgery with curative intent, chemotherapy (CT), radiotherapy (RT), recurrence patterns and overall survival (OS) were analyzed. Results: The cohort includes 549 (52%) males, PS of 0-1 in 850 (80%), 2-3 in 87 (8%) pts. A histological diagnosis of adenocarcinoma was confirmed in 885 (84%), 106 (10%) non diagnostic, 66 (6%) other. Definitive surgery was performed in 41% and adjuvant CT or concurrent CT/RT given in 20% and 8% respectively. CT or CT/RT was given for unresectable/metastatic disease in first line palliative setting in 395 (37%) and 18 pts (5%) respectively. Response to first line CT in GBC was 33% vs. 24% in CC (p=0.005) and med survival was 8.4 and 13.1 mo respectively (p=0.001). The OS for entire cohort of 1057 pts was 19.3 mo with survival for breakdown of tumor type, stage detailed in the table. At this time, 207 (20%) are still alive, 609 (58%) deceased, status unknown/pending in 241 (22%). Conclusions: This represents a large biliary cancer cohort with survival benchmarks obtained in modern era of multidisciplinary care. Different subsites clearly present at different stages and have different prognosis with treatments. Despite better responses for advanced disease on CT in GBC, survival was better in CC consistent with reported literature. Therapeutic advancement mandates finding additional drug options and appropriate adjuvant care. [Table: see text]
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