Surgical strategy for bile duct cancer: Advances and current limitations

Table 3 Review of the literature on adjuvant therapy for surgically resected bile duct cancer

Author	Yr	Background			P-value	Comments
Chemotherapy			Without chemotherapy	With chemotherapy
Takada et al[186]	2002	Curative-resection	28% 5-yr OS	41% 5-yr OS	0.48	Two courses of mitomycin C plus infusional 5-FU, followed by oral 5-FU until tumor progression; 40% received a non-curative operation
		Non-curative resection	16% 5-yr OS	8% 5-yr OS	0.300
Yubin et al[187]	2008	Hilar cholangiocarcinoma	37 mo MS	43 mo MS	< 0.05	Infusional gemcitabine based; no discrimination between curative and palliative resection; some of patients received radiation but the contribution of radiation was not analyzed
Murakami et al[160]	2009	Hilar cholangiocarcinoma	23% 5-yr OS	57% 5-yr OS	0.026	Infusional gemcitabine and oral S-1, every 2 wk
Radiation			Without radiation	With radiation
Pitt et al[188]	1995	Hilar cholangiocarcinoma	20 mo MS	20 mo MS	NS
Cameron et al[189]	1990	Hilar cholangiocarcinoma	21% 3-yr OS	21% 3-yr OS	NS
Zlotecki et al[190]	1998	Bile duct cancer	19% 5-yr OS	35% 5-yr OS	NS
Heron et al[195]	2003	Distal cholangiocarcinoma	63 mo MS	MS not reached (> 129 mo)	NS
Gonzalez et al[194]	1999	Hilar cholangiocarcinoma Hilar cholangiocarcinoma			0.023
			8 mo MS	19 mo MS	0.001
Schoenthaler et al[193]	1994	R1 resection	11 mo MS	22 mo MS, X-rays	0.010
				61 mo MS, charged particles	0.001
Cheng et al[192]	2007	Hilar cholangiocarcinoma	HR 4.3, 95% CI 3.6-4.9		< 0.01	Radiation was significantly helpful for R1/2 resection patients
Todoroki et al[191]	2000	Bile duct cancer	14% 5-yr OS	34% 5-yr OS	0.010	Radiation was significantly helpful for R1 resection patients
Gerhards et al[197]	2003	Hilar cholangiocarcinoma	8 mo MS	24 mo MS	< 0.05
Chemoradiation			Without chemoradiation	With chemoradiation
Nakeeb et al[198]	2002	Bile duct cancer	11 mo MS (Chemotherapy alone)	16 mo OS	0.020	Chemotherapy; 5-FU
			8 mo MS (Radiation alone)
Kim et al[199]	2002	Bile duct cancer	9% 5-yr OS (Radiation alone)	41% 5-yr OS	0.0005	Chemotherapy; 5-FU, P = 0.14 in multivariate analysis
Serafini et al[200]	2001	Bile duct cancer	29 mo MS (Surgery alone)	42 mo MS	0.07	Chemotherapy; 5-FU; when stratified by location, only distal tumors significantly benefited (41 mo MS vs 25 mo MS, P < 0.05)
Hughes et al[201]	2007	Distal cholangiocarcinoma	22 mo MS (Surgery alone)	37 mo MS	0.04	Chemotherapy; 5-FU

MS: Mean survival; NS: Not significant; OS: Overall survival; R1: Microscopically positive margin; R2: Macroscopically positive margin; HR: Hazard ratio; CI: Confidential interval.