Background: Surgical resection is the only curative treatment for extrahepatic bile duct cancer. Additionally, the recurrence rate after curative surgery is relatively high, requiring adjuvant therapy. However, the efficacy of adjuvant chemotherapy compared with surgery alone has not yet been clarified. This study aimed to evaluate the efficacy of adjuvant chemotherapy and identify prognostic factors influencing survival in extrahepatic bile duct cancer patients who underwent curative surgical resection. Methods: Ninety-seven patients with extrahepatic bile duct cancer who underwent curative resection between January 2005 and December 2010 were retrospectively analyzed. Results: Among the 97 patients, 31 underwent adjuvant chemotherapy and 66 did not. The 5-year overall survival rate was 34% for patients who underwent adjuvant chemotherapy. There was no significant difference for overall survival between patients who underwent adjuvant chemotherapy and those who did not (p = 0.228). On multivariate analysis, postoperative carbohydrate antigen 19-9 levels and histologic grade were independent prognostic factors related to long-term survival (p < 0.05). Conclusions: Postoperative adjuvant chemotherapy did not improve survival after surgical resection for extrahepatic bile duct cancer.

Keywords:
Prognostic factor, Extrahepatic bile duct cancer, Overall survival, Adjuvant chemotherapy
1.
Anderson CD, Pinson CW, Berlin J, Chari RS: Diagnosis and treatment of cholangiocarcinoma. Oncologist 2004;9:43-57.
2.
Howlader N, Noone AN, Krapcho M, et al (eds): SEER Cancer Statistics Review, 1975-2008. Bethesda, National Cancer Institute, 2011.
3.
Nakeeb A, Pitt HA, Sohn TA, Coleman J, Abrams RA, Piantadosi S, Hruban RH, Lillemoe KD, Yeo CJ, Cameron JL: Cholangiocarcinoma: a spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 1996;224:463-473; discussion 473-465.
4.
Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD: Cholangiocarcinoma. Lancet 2005;366:1303-1314.
5.
Klempnauer J, Ridder GJ, von Wasielewski R, Werner M, Weimann A, Pichlmayr R: Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 1997;15:947-954.
6.
Jarnagin WR, Shoup M: Surgical management of cholangiocarcinoma. Semin Liver Dis 2004;24:189-199 .
7.
Edge S, Byrd DR, Compton CC, et al (eds): AJCC Cancer Staging Handbook, ed 7. New York, Springer, 2010.
8.
Murakami Y, Uemura K, Hayashidani Y, Sudo T, Hashimoto Y, Ohge H, Sueda T: Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma. J Surg Oncol 2007;95:207-212.
9.
Pracht M, Le Roux G, Sulpice L, Mesbah H, Manfredi S, Audrain O, Boudjema K, Raoul JL, Boucher E: Chemotherapy for inoperable advanced or metastatic cholangiocarcinoma: retrospective analysis of 78 cases in a single center over four years. Chemotherapy 2012;58:134-141.
10.
Itoh H, Nishijima K, Kurosaka Y, Takegawa S, Kiriyama M, Dohba S, Kojima Y, Saitoh Y: Magnitude of combination therapy of radical resection and external beam radiotherapy for patients with carcinomas of the extrahepatic bile duct and gallbladder. Dig Dis Sci 2005;50:2231-2242.
11.
Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nimura Y, Nagino M: Surgical treatment of hilar cholangiocarcinoma in the ‘new era': the Nagoya University experience. J Hepatobiliary Pancreat Sci 2010;17:449-454.
12.
Hasegawa S, Ikai I, Fujii H, Hatano E, Shimahara Y: Surgical resection of hilar cholangiocarcinoma: analysis of survival and postoperative complications. World J Surg 2007;31:1256-1263.
13.
Horgan AM, Amir E, Walter T, Knox JJ: Adjuvant therapy in the treatment of biliary tract cancer: a systematic review and meta-analysis. J Clin Oncol 2012;30:1934-1940.
14.
Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, Sakabe R, Ohge H, Sueda T: Prognostic factors after surgical resection for intrahepatic, hilar, and distal cholangiocarcinoma. Ann Surg Oncol 2011;18:651-658.
15.
Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T: Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer 2002;95:1685-1695.
16.
Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakamura H, Nakashima A, Sueda T: Gemcitabine-based adjuvant chemotherapy improves survival after aggressive surgery for hilar cholangiocarcinoma. J Gastrointest Surg 2009;13:1470-1479.
17.
Park JH, Choi EK, Ahn SD, Lee SW, Song SY, Yoon SM, Kim YS, Lee YS, Lee SG, Hwang S, Lee YJ, Park KM, Kim TW, Chang HM, Lee JL, Kim JH: Postoperative chemoradiotherapy for extrahepatic bile duct cancer. Int J Radiat Oncol Biol Phys 2011;79:696-704.
18.
Wirasorn K, Ngamprasertchai T, Khuntikeo N, Pakkhem A, Ungarereevittaya P, Chindaprasirt J, Sookprasert A: Adjuvant chemotherapy in resectable cholangiocarcinoma patients. J Gastroenterol Hepatol 2013;28:1885-1891.
19.
Yubin L, Chihua F, Zhixiang J, Jinrui O, Zixian L, Jianghua Z, Ye L, Haosheng J, Chaomin L: Surgical management and prognostic factors of hilar cholangiocarcinoma: experience with 115 cases in China. Ann Surg Oncol 2008;15:2113-2119.
20.
Choi SB, Park SW, Kim KS, Choi JS, Lee WJ: The survival outcome and prognostic factors for middle and distal bile duct cancer following surgical resection. J Surg Oncol 2009;99:335-342.
21.
Henson DE, Albores-Saavedra J, Corle D: Carcinoma of the extrahepatic bile ducts: histologic types, stage of disease, grade, and survival rates. Cancer 1992;70:1498-1501.
22.
Jarnagin WR, Ruo L, Little SA, Klimstra D, D'Angelica M, DeMatteo RP, Wagman R, Blumgart LH, Fong Y: Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer 2003;98:1689-1700.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.