Patterns of Initial Disease Recurrence after Resection of Biliary Tract Cancer

Abstract

Objectives: This study aimed to provide further insights into the indications for adjuvant therapeutic strategies via analysis of the sites of initial recurrence after resection of gallbladder cancer (GBC) and intrahepatic (IHC) and extrahepatic cholangiocarcinoma (EHC). Methods: Patients with biliary tract cancer who underwent potentially curative resection were identified from the database. Sites of initial disease recurrence were categorized as locoregional or distant. Results: Between March 2001 and April 2009, 231 patients underwent curative resection. Initial GBC and IHC recurrence involving a distant site occurred in 70.8 and 86.8% patients, respectively, compared to 56.9% patients with EHC (p = 0.002). The median time to disease recurrence (TTR) was shorter among the GBC and IHC groups compared with that in EHC patients (6.3 and 6.7 vs. 13.1 months, respectively; p = 0.003). Moreover, median times to distant recurrence in GBC and IHC groups were shorter than that in EHC (5.8 and 6.5 vs. 14.1 months, respectively; p = 0.002). Conclusions: After resection, recurrent GBC and IHC are more likely to involve a distant site and are associated with significantly shorter TTR than recurrent EHC. These findings suggest that an adjuvant therapeutic strategy targeting distant disease is likely to have a significant impact on the overall management of GBC and IHC.

Gemcitabine plus Cisplatin versus Capecitabine plus Cisplatin as First-Line Chemotherapy for Advanced Biliary Tract Cancer: A Retrospective Cohort Study

“…Moreover, the majority of patients who undergo curative resection experience tumor recurrence or metastasis [5]. Therefore, systemic chemotherapy has become a mainstay of treatment for most patients with BTC [6,7].…”

Clinical Target Volume in Biliary Carcinoma: A Systematic Review of Pathological Studies

“…Park and colleagues showed that more than 60% of patients with resected extrahepatic biliary cancer had llocoregional recurrence (22). Jung and coworkers reported even higher locoregional recurrence rates, of 70%, 86%, and 57%, in patients with gallbladder, intrahepatic, and extrahepatic cancer, respectively (23). Several retrospective studies have shown that chemoradiation can improve local control and overall survival in selected patients in both adjuvant and neoadjuvant settings (3)(4)(5).…”

Effect of Adjuvant Gemcitabine Combined with Low-dose 5-Fluorouracil and Cisplatin Chemotherapy for Advanced Biliary Carcinoma

“…One meta-analysis revealed that chemotherapy or chemoradiotherapy had a statistically greater benefit than radiotherapy alone (32). It has also been reported that remote organ metastasis is more frequently observed than locoregional recurrence of biliary carcinoma after surgery (28)(29)(30)(31). Therefore, adjuvant treatment with systemic chemotherapy might have some advantage in the regulation of recurrences after drastic local treatment such as surgery as compared with local radiotherapy.…”