Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 7, 2013; 19(1): 72-77
Published online Jan 7, 2013. doi: 10.3748/wjg.v19.i1.72
Improvement of prognosis for unresectable biliary tract cancer
Takashi Sasaki, Hiroyuki Isayama, Yousuke Nakai, Naminatsu Takahara, Naoki Sasahira, Hirofumi Kogure, Suguru Mizuno, Hiroshi Yagioka, Yukiko Ito, Natsuyo Yamamoto, Kenji Hirano, Nobuo Toda, Minoru Tada, Masao Omata, Kazuhiko Koike
Takashi Sasaki, Hiroyuki Isayama, Yousuke Nakai, Naminatsu Takahara, Naoki Sasahira, Hirofumi Kogure, Natsuyo Yamamoto, Kenji Hirano, Minoru Tada, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Suguru Mizuno, Department of Gastroenterology, Kanto Central Hospital, Tokyo 158-8531, Japan
Hiroshi Yagioka, Department of Gastroenterology, JR Tokyo General Hospital, Tokyo 151-8528, Japan
Yukiko Ito, Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
Nobuo Toda, Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo 101-8643, Japan
Masao Omata, Yamanashi Prefectural Hospital Organization, Yamanashi 400-8506, Japan
Author contributions: Sasaki T designed the study, analyzed the data and worked on the manuscript; Isayama H designed the study concept; Nakai Y analyzed the data and worked on the manuscript; Takahara N, Sasahira N, Kogure H, Mizuno S, Yagioka H, Ito Y and Toda N collected the clinical data; Yamamoto N, Hirano K and Tada M performed the analysis; Omata M and Koike K supervised and overviewed the study.
Correspondence to: Takashi Sasaki, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. sasakit-tky@umin.ac.jp
Telephone: +81-3-38155411 Fax: +81-3-38140021
Received: July 1, 2012
Revised: September 17, 2012
Accepted: September 22, 2012
Published online: January 7, 2013
Abstract

AIM: To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.

METHODS: A total of 186 consecutive patients with unresectable biliary tract cancer, who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan, were retrospectively analyzed. These patients were divided into three groups based on the year beginning chemotherapy: Group A (2000-2003), Group B (2004-2006), and Group C (2007-2009). The data were fixed at the end of December 2011. Overall survival and time-to-progression were analyzed and compared chronologically.

RESULTS: No patient characteristics were significantly different among the three groups. The gallbladder was involved in about half of the patients in each group, and metastatic biliary tract cancer was present in three quarters of the enrollees. In Group A, 5-fluorouracil-based chemotherapies were primarily selected as first-line chemotherapy, and only 24% were treated with second-line chemotherapy. In Group B, gemcitabine or S-1 monotherapy was mainly introduced as first-line chemotherapy, and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with monotherapy. In Group C, the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy, and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination therapy. The median time-to-progressions were 4.4 mo, 3.5 mo and 5.9 mo in Groups A, B and C, respectively (4.4 mo vs 3.5 mo vs 5.9 mo, P < 0.01). The median overall survivals were 7.1, 7.3, and 11.7 mo in Groups A, B and C (7.1 mo vs 7.3 mo vs 11.7 mo, P = 0.03). Induction rates of all three drugs (gemcitabine, platinum analogs, and fluoropyrimidine) in Groups A, B and C were 4%, 2% and 27% (4% vs 2% vs 27%, P < 0.01).

CONCLUSION: The prognosis of unresectable biliary tract cancer has improved recently. Using three effective drugs (gemcitabine, platinum analogs, and fluoropyrimidine) may improve the prognosis of this cancer.

Keywords: Unresectable, Biliary tract cancer, Gemcitabine, Platinum analogs, Fluoropyrimidine