Cancer Res Treat.  2018 Jul;50(3):791-800. 10.4143/crt.2017.044.

Chemotherapy versus Best Supportive Care in Advanced Biliary Tract Carcinoma: A Multi-institutional Propensity Score Matching Analysis

• Ji JH
• Kim YS
• Park I
• Lee SI
• Kim RB
• Park JO
• Oh SY
• Hwang IG
• Jang JS
• Song HN
• Kang JH

• KMID: 2417868
• DOI: http://doi.org/10.4143/crt.2017.044

Abstract

PURPOSE
Although chemotherapy is recommended by various guidelines for advanced biliary tract cancer (BTC), the evidence supporting its use over best supportive care (BSC) is limited. The aim of this study was to investigate the survival benefit of chemotherapy over that of BSC in advanced BTC patients.
MATERIALS AND METHODS
Advanced BTC patientswith a good performance status (Eastern CooperativeOncologyGroup [ECOG] 0-2) were eligible for the study. Data were retrospectively collected from four tertiary cancer centers and analyzed using propensity score matching (PSM). Of the 604 patients enrolled, 206 received BSC and 398 received chemotherapy. PSM analysis was performed using the following variables: age, ECOG status, carcinoembryonic antigen (CEA) level, white blood cell level, albumin level, total bilirubin level, and aspartate aminotransferase level. The sample size of each group was 164 patients after PSM. Median survival was compared between the two groups by using the Kaplan-Meier method, and prognostic factors were investigated using Cox proportional regression analysis.
RESULTS
In post-PSM analysis, the respective median survival for the chemotherapy and BSC groups was dependent on the following prognostic factors: total population, 12.0 months vs. 7.5 months (p=0.001); locally advanced disease, 16.7 months vs. 13.4 months (p=0.490); cancer antigen 19-9 ≤ 100 IU/mL, 12.7 months vs. 10.6 months (p=0.330); and CEA ≤ 3.4 ng/mL, 17.1 months vs. 10.6 months (p=0.052).
CONCLUSION
Chemotherapy improved overall survival of patients with advanced BTC who had a good performance status. However, this survival benefit was not observed in BTC patients with locally advanced disease or with lower tumor marker. Individualized approach is needed for initiation of palliative chemotherapy in advanced BTC.

Keyword

Drug therapy; Observation; Survival analysis; Biliary tract neoplasms; Propensity score

MeSH Terms

Aspartate Aminotransferases
Biliary Tract Neoplasms
Biliary Tract*
Bilirubin
Carcinoembryonic Antigen
Drug Therapy*
Humans
Leukocytes
Methods
Propensity Score*
Retrospective Studies
Sample Size
Survival Analysis
Aspartate Aminotransferases
Bilirubin
Carcinoembryonic Antigen

Figure

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  Fig. 1. All cohort (after propensity score matching analysis). CG, chemotherapy group; BSCG, best supportive care group; OS, overall survival.

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  Fig. 2. Subgroup cohort (after propensity score matching analysis). CG, chemotherapy group; BSCG, best supportive care group; OS, overall survival; CA 19-9, cancer antigen 19-9; CEA, carcinoembryonic antigen; ECOG, Eastern Cooperative Oncology Group.

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  Fig. 3. Forest plot: comparison of CG versus BSCG. CI, confidence interval; CA 19-9, cancer antigen 19-9; CEA, carcinoembryonic antigen; ECOG, Eastern Cooperative Oncology Group; CG, chemotherapy group; BSCG, best supportive care group.

Reference

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