The role of adjuvant chemoradiotherapy in non-hilar extrahepatic bile duct cancer: A long term single institutional analysis.

Abstract

PURPOSE\nDespite frequent use in the clinical setting, especially for patients with high risk factors for relapse, the role of adjuvant treatment has not been clarified in non-hilar extrahepatic bile duct cancer (NH-EHBDC). The goal of this study is to identify the role of adjuvant chemoradiotherapy (CRT) in NH-EHBDC patients after radical surgery.\n\n\nMETHODS AND MATERIALS\nNH-EHBDC patients who underwent radical surgery from July 2007 to December 2018 were retrospectively reviewed. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Subgroup analyses were carried out to further identify the role of adjuvant CRT.\n\n\nRESULTS\nThree hundred thirty-three patients were accrued. At a median follow-up of 36.7 months (range, 1.0-144.2 months), the 3-year LRRFS, DMFS, DFS, and OS were 63.4%, 59.0%, 53.3%, and 67.7%, respectively. In multivariate analysis, adjuvant CRT was an independent prognostic factor for LRRFS, DMFS, DFS, and OS (p < 0.05). For patients with nodal involvement, pT3 stage, tumor size ≥ 5cm, poorly-differentiated tumor, and R1 resection, adjuvant CRT significantly improved DFS (p < 0.05).\n\n\nCONCLUSIONS\nIn NH-EHBDC patients, adjuvant CRT significantly improved LRRFS and DFS. For patients with risk factors such as nodal involvement, pT3 stage, poorly-differentiated tumor, tumor size ≥ 5 cm, or R1 resection, adjuvant CRT may contribute to improve treatment outcomes.