Chemotherapy Improves Survival After Percutaneous Biliary Drainage in Patients With Pancreatic or Biliary Tract Cancer With Biliary Obstruction

Abstract

Background: The survival benefit of chemotherapy compared to best supportive care (BSC) after percutaneous transhepatic biliary drainage (PTBD) was evaluated in patients with pancreatic or biliary tract cancer. Patients and Methods: A retrospective registry study was conducted at a tertiary-level university hospital. The endpoint was survival measured from the PTBD and the initiation of chemotherapy. Results: Among 158 patients (mean age=74 years, range=43-93 years; 51.9% women), 82 (51.9%) had pancreatic cancer and 76 (48.1%) had biliary tract cancer. After PTBD, 32 (20.3%) patients received chemotherapy and had a median survival of 11.7 months; 126 (79.7%) patients received only BSC resulting in a median survival of 1.7 months. The hazard ratio for survival at 1 year for patients who received chemotherapy compared to BSC was 0.22 (95% confidence interval=0.12-0.41, p<0.001). Conclusion: After PTBD, patients with pancreatic or biliary tract cancer should be critically evaluated by an oncologist to determine whether chemotherapy is possible, as it seems to significantly improve survival compared to BSC.

Salvage PTBD With Chemotherapy Improves Survival in Patients With Unresectable Malignant Biliary Obstruction – A Single Center Retrospective Study

“…In addition, poorer prognosis was independently predicted by an ASA PS 4 and ECOG PS 4. The overall median survival in our cohort was only 4.2 months after drainage, which is in agreement with previous reports (9)(10)(11)(12)(13)(14)(15)(16). In this study, the standard chemotherapy for biliary tract cancer was gemcitabine or S-1 alone.…”

“…Prognosis was slightly better in patients with ASA PS3, who showed a median overall survival of 6.1 months and of whom four patient (25%) were alive at 1-year post-drainage. Prior studies have reported similar results (16).…”

“…In our series, the median survival was 11.2 months for patients with biliary tract cancer who received chemotherapy after PTBD and 5.4 months for those who received the best supportive care. Niemela et al (16) reported a better median survival of 15.1 months in patients who can undergo chemotherapy after palliative PTBD, and a poor median survival of 1.9 months in patients unable to receive chemotherapy. Recently, the combination of gemcitabine and S-1 or cisplatin has been shown to significantly improve the outcomes of patients with advanced/recurrent biliary tract cancer (17).…”

“…Recently, the combination of gemcitabine and S-1 or cisplatin has been shown to significantly improve the outcomes of patients with advanced/recurrent biliary tract cancer (17). The survival figures may have been even better for our patients by introducing a new combination chemotherapy (16).…”

A real-world analysis of nanoliposomal-irinotecan with 5-fluorouracil and folinic acid as third- or later-line therapy in patients with metastatic pancreatic adenocarcinoma

“…We calculated survival outcomes from the date of initiating nal-IRI plus 5-FU/LV treatment to avoid time bias. 24 , 25 However, time-lead bias still exists in the analysis of total survival because patients who received chemotherapy beyond second-line therapy could not have died prior to third-line therapy. The effectiveness of nal-IRI + 5-FU/LV as a third- or later-line therapy can be further clarified through comparative study deigns that include patients receiving other chemotherapy regimens or active symptom control.…”