P-0144 Adjuvant Therapy and Prognostic Factors for Biliary Tract Cancer Intrahepatic Cholangiocarcinoma: Single-Center Experience

Abstract

ABSTRACT Introduction Biliary tract cancers (BTCs) encompass both cholangiocarcinoma (CC), arising in the intrahepatic, or distal biliary tree, ampulla of Vater and gallbladder carcinoma (GBC). The prognosis is poor for the majority of these patients (pts).The treatment outcome and prognostic factors for survival in patients with peripheral intrahepatic cholangiocarcinoma (ICC) are poorly defined. Given the rarity of BTC compared with other solid tumours, there have been few large studies looking at long-term outcomes. Methods 43pts with a diagnosis of no metastatic BTC were followed from diagnosis to death between Jan 2000 and Mar 2011. We calculated survival rates and prognostic factors for global survival and disease free survival. Results A total of 43 patients were identified with no metastatic BTCs. The median age was 65 years (29–82 years); 25/43 pts (58%) males, performance status of 0 in 33/43 (76%); PS1 in 8/43 (19%) and PS2 in 2/43 (5%) pts. A histological diagnosis of adenocarcinoma was confirmed in 100%. Localization of CC: 26% (11/43) intrahepatic, 9% (4/43) distal choledochal tract, 42% (18/43) gallbladder and 10/43 (23%) ampulla of Vater. Surgical resection was performed in all patients. After resection 12% (5/43) had positive margins, 42% (18/43) had positive nodes, 15/43 (35%) perineural invasion, and 3/43 (7%) had vascular infiltration. The pathologic stage was T1-T2 in 19/43 (44%) and T3-T4 in 24/43 (56%). Adjuvant chemoradiotherapy had 31/43 (72%), preferred with gemcitabine and a median number of cycles 6. Grade 3 or 4 toxicities rarely occurred. During median follow-up of 6.6 years tumor recurrence or metastatic disease occurred in 63% with median survival global were 2 years and 1.5 years for disease free survival. For stage T, the median survival global rates were 58 months (95% CI 44.6-71.3) for T1-T2 and 35 months (95% CI 23.3-46.8) for T3-T4 (p=0.015) and for median recidive-free survival were 23 months (95% CI 11.8-34) for T1-T2 and 14 months (95% CI 6.5-21) for T3-T4 (p=0.05). For N stage, the median survival global were 58 months (95% CI 50.5-65.4) for negative nodes and 26 months (95% CI 3.7-48.2) for positive nodes (p=0.003) and for median recidive-free survival were 55 months (95% CI 31.7-57.5) for negative nodes and 10 months (95% CI 6.8-13) for positive nodes (p=0.006). The vascular infiltration was significance statics for median recidive-free survival was 10 months (95% CI 2-15) for positive vascular infiltration and 23 months (95% CI 14.5-31.4) for negative vascular infiltration (p=0.006) but no for SG. Further, only stage T, N and vascular infiltration were independent predictors of survival. Conclusion This represents a biliary cancer cohort with survival benchmarks obtained in the modern era of multidisciplinary care. Surgical resection and adjuvant chemotherapy offers the optimal treatment outcome in patients with ICC. From our results depth of tumor invasion (T), the presence the lymph node metastases (N) and vascular infiltration are the strongest predictors of relapse and survival.