Adjuvant Chemotherapy in Resectable Cholangiocarcinoma Patients

Kosin Wirasorn; Thundon Ngamprasertchai; Narong Khuntikeo; Ake Pakkhem; Piti Ungarereevittaya; Jarin Chindaprasirt; Aumkhae Sookprasert


J Gastroenterol Hepatol. 2013;28(12):1885-1891. 

In This Article


Patient's Characteristics and Tumor Data

Two hundred sixty-three curative resectable cholangiocarcinoma patients were enrolled. The patients' characteristics are presented in Table 1 . There were 138 patients who received AC. This group had a significantly lower mean age than patients without chemotherapy. Abdominal pain and jaundice were the first and second common presenting symptoms. The majority of the patients had normal BMIs, a level of serum total bilirubin below 10 mg/dL, a level of serum cholesterol below 200 mg/dL, and a level of serum albumin above 3 g/dL. The level of serum albumin above 3 g/dL was more prevalent in the AC group than the NAC one (87.7% vs 79.2%, P = 0.04). Most patients had tumor at an intrahepatic location with advanced stages, that is, stage III or IV. Tumor data according to the group of treatment is also shown in Table 1 . The combination of 5-FU and mitomycin C was the most common regimen in the AC group. The details of each chemotherapeutic regimen were presented in Appendix I .

Figure 1 shows the Kaplan–Meier curves for overall survival. Patients who received AC had significantly longer overall median survival time of 21.6 versus 13.4 months, P = 0.01, and were 35% less likely to die at any time earlier than those who did not receive adjuvant treatment (hazard ratio, 0.65; 95% confidence interval, 0.47–0.91). The survival rate of the AC group was longer than control group (1-year survival rate 71.5% vs 58.8%, 2-year survival rate 48.4% vs 41.7%, and 3-year survival rate 40.1% vs 29.4%).

Figure 1.

Patients who received adjuvant chemotherapy had significantly longer overall median survival time (21.6 vs 13.4 months, P = 0.01).

Among all chemotherapy regimens, patients with the combination of gemcitabine and capecitabine regimen had the longest survival time (median overall survival time of gemcitabine and capecitabine 31.5, 5-FU and mitomycin C 17.3, 5-FU alone 22.2, capecitabine alone 21.6, and gemcitabine alone 7.9 months, P = 0.02) which presented in Figure 2. Figure 3 reveals the hazard ratios for death according to baseline prognostic factors. The benefits of AC were likely to be found in patients who had high-risk features, that is, high level of CA19–9, advanced stage, T4 stage, nodal involvement, and a positive microscopic surgical margin.

Figure 2.

Among patients who received chemotherapy, patients with combination of gemcitabine and capecitabine had the longest survival time (P = 0.02).

Figure 3.

Hazard ratio, according to groups and base line prognostic factors. *Indicates P-value < 0.05.