In biliary tract cancer, adjuvant therapy linked to better survival

  • Eur J Surg Oncol

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Adjuvant therapy is associated with better survival in biliary tract cancer than surgery alone.

Why this matters

  • Overall analysis and analysis of randomized trials alone yield similar results.

Study design

  • Meta-analysis of 35 studies (n=42,917; surgery alone, n=27,046; adjuvant therapy, n=15,871).
  • Funding: NIHR BRC Southampton.

Key results

  • Adjuvant therapy was associated with better survival than surgery alone (HR, 0.74; P<.001>
  • A subgroup analysis that included only randomized controlled trials (5 trials) also showed a benefit (HR, 0.81; P<.001>
  • Sensitivity analyses showed a similar benefit of adjuvant therapy whether it took the form of chemotherapy or chemoradiotherapy:
    • Gallbladder cancer: chemotherapy HR, 0.87 (P=.037); chemoradiotherapy HR, 0.51 (P=.017).
    • Bile duct cancer: chemotherapy HR, 0.77 (P<.001 chemoradiotherapy hr>
  • Kaplan-Meier data showed that adjuvant therapy was associated with a median survival:
    • Gallbladder cancer: 31.5 (95% CI, 30-33) months vs 19.3 (95% CI, 18.8-19.8) months with surgery alone (P<.001>
    • Bile duct cancer: 42.4 (95% CI, 39.7-44.9) months vs 39 (95% CI, 36-40.5) months with surgery alone (P=.0066).
  • Adjuvant therapy was associated with better survival in patients after margin positive surgery (risk ratio [RR], 0.83; P<.001 and in node-positive disease p>

Limitations

  • Most included studies were cohort studies.