R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer

Wolf Rudiger Matull, Dipok K. Dhar, Lakshmana Ayaru, Neomal S. Sandanayake, Michael H. Chapman, Aruna Dias, John Bridgewater, George J M Webster, Jin J. Bong, Brian R. Davidson, Stephen P. Pereira

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: There is a need for better management strategies to improve the survival and quality of life in patients with biliary tract cancer (BTC).Aim: To assess prognostic factors for survival in a large, non-selective cohort of patients with BTC.Method: We compared outcomes in 321 patients with a final diagnosis of BTC (cholangiocarcinoma n=237, gallbladder cancer n=84) seen in a tertiary referral cancer centre between 1998 and 2007. Survival according to disease stage and treatment category was compared using log-rank testing. Cox's regression analysis was used to determine independent prognostic factors.Results: Eighty-nine (28%) patients underwent a surgical intervention with curative intent, of whom 38% had R0 resections. Among the 321 patients, 34% were given chemo- and/or radiotherapy, 14% were palliated with photodynamic therapy (PDT) and 37% with biliary drainage procedures alone. The overall median survival was 9 months (3-year survival, 14%). R0-resective surgery conferred the most favourable outcome (3-year survival, 57%). Although patients palliated with PDT had more advanced clinical T-stages, their survival was similar to those treated with attempted curative surgery but who had positive resection margins. On multivariable analysis, treatment modality, serum carbohydrate-associated antigen 19-9, distant metastases and vascular involvement were independent prognostic indicators of survival.Conclusion: In this large UK series of BTC, palliative PDT resulted in survival similar to those with curatively intended R1/R2 resections. Surgery conferred a survival advantage only in patients with R0 resection margins, emphasising the need for accurate pre-operative staging.

Original languageEnglish
Pages (from-to)99-107
Number of pages9
JournalLiver International
Volume31
Issue number1
DOIs
Publication statusPublished - Jan 2011
Externally publishedYes

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Biliary Tract Neoplasms
Photochemotherapy
Palliative Care
Survival
Gallbladder Neoplasms
Cholangiocarcinoma
Tertiary Care Centers
Blood Vessels
Drainage
Radiotherapy
Regression Analysis
Carbohydrates
Quality of Life

Keywords

  • Biliary tract cancer
  • Photodynamic therapy
  • Prognosis
  • Surgical resection

ASJC Scopus subject areas

  • Hepatology

Cite this

Matull, W. R., Dhar, D. K., Ayaru, L., Sandanayake, N. S., Chapman, M. H., Dias, A., ... Pereira, S. P. (2011). R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer. Liver International, 31(1), 99-107. https://doi.org/10.1111/j.1478-3231.2010.02345.x

R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer. / Matull, Wolf Rudiger; Dhar, Dipok K.; Ayaru, Lakshmana; Sandanayake, Neomal S.; Chapman, Michael H.; Dias, Aruna; Bridgewater, John; Webster, George J M; Bong, Jin J.; Davidson, Brian R.; Pereira, Stephen P.

In: Liver International, Vol. 31, No. 1, 01.2011, p. 99-107.

Research output: Contribution to journalArticle

Matull, WR, Dhar, DK, Ayaru, L, Sandanayake, NS, Chapman, MH, Dias, A, Bridgewater, J, Webster, GJM, Bong, JJ, Davidson, BR & Pereira, SP 2011, 'R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer', Liver International, vol. 31, no. 1, pp. 99-107. https://doi.org/10.1111/j.1478-3231.2010.02345.x
Matull, Wolf Rudiger ; Dhar, Dipok K. ; Ayaru, Lakshmana ; Sandanayake, Neomal S. ; Chapman, Michael H. ; Dias, Aruna ; Bridgewater, John ; Webster, George J M ; Bong, Jin J. ; Davidson, Brian R. ; Pereira, Stephen P. / R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer. In: Liver International. 2011 ; Vol. 31, No. 1. pp. 99-107.
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AU - Dhar, Dipok K.

AU - Ayaru, Lakshmana

AU - Sandanayake, Neomal S.

AU - Chapman, Michael H.

AU - Dias, Aruna

AU - Bridgewater, John

AU - Webster, George J M

AU - Bong, Jin J.

AU - Davidson, Brian R.

AU - Pereira, Stephen P.

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N2 - Background: There is a need for better management strategies to improve the survival and quality of life in patients with biliary tract cancer (BTC).Aim: To assess prognostic factors for survival in a large, non-selective cohort of patients with BTC.Method: We compared outcomes in 321 patients with a final diagnosis of BTC (cholangiocarcinoma n=237, gallbladder cancer n=84) seen in a tertiary referral cancer centre between 1998 and 2007. Survival according to disease stage and treatment category was compared using log-rank testing. Cox's regression analysis was used to determine independent prognostic factors.Results: Eighty-nine (28%) patients underwent a surgical intervention with curative intent, of whom 38% had R0 resections. Among the 321 patients, 34% were given chemo- and/or radiotherapy, 14% were palliated with photodynamic therapy (PDT) and 37% with biliary drainage procedures alone. The overall median survival was 9 months (3-year survival, 14%). R0-resective surgery conferred the most favourable outcome (3-year survival, 57%). Although patients palliated with PDT had more advanced clinical T-stages, their survival was similar to those treated with attempted curative surgery but who had positive resection margins. On multivariable analysis, treatment modality, serum carbohydrate-associated antigen 19-9, distant metastases and vascular involvement were independent prognostic indicators of survival.Conclusion: In this large UK series of BTC, palliative PDT resulted in survival similar to those with curatively intended R1/R2 resections. Surgery conferred a survival advantage only in patients with R0 resection margins, emphasising the need for accurate pre-operative staging.

AB - Background: There is a need for better management strategies to improve the survival and quality of life in patients with biliary tract cancer (BTC).Aim: To assess prognostic factors for survival in a large, non-selective cohort of patients with BTC.Method: We compared outcomes in 321 patients with a final diagnosis of BTC (cholangiocarcinoma n=237, gallbladder cancer n=84) seen in a tertiary referral cancer centre between 1998 and 2007. Survival according to disease stage and treatment category was compared using log-rank testing. Cox's regression analysis was used to determine independent prognostic factors.Results: Eighty-nine (28%) patients underwent a surgical intervention with curative intent, of whom 38% had R0 resections. Among the 321 patients, 34% were given chemo- and/or radiotherapy, 14% were palliated with photodynamic therapy (PDT) and 37% with biliary drainage procedures alone. The overall median survival was 9 months (3-year survival, 14%). R0-resective surgery conferred the most favourable outcome (3-year survival, 57%). Although patients palliated with PDT had more advanced clinical T-stages, their survival was similar to those treated with attempted curative surgery but who had positive resection margins. On multivariable analysis, treatment modality, serum carbohydrate-associated antigen 19-9, distant metastases and vascular involvement were independent prognostic indicators of survival.Conclusion: In this large UK series of BTC, palliative PDT resulted in survival similar to those with curatively intended R1/R2 resections. Surgery conferred a survival advantage only in patients with R0 resection margins, emphasising the need for accurate pre-operative staging.

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