Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18452
Revised: June 9, 2014
Accepted: July 15, 2014
Published online: December 28, 2014
Processing time: 258 Days and 10.3 Hours
AIM: To evaluate the differences in the treatment outcomes between the unresectable and recurrent biliary tract cancer patients who received chemotherapy.
METHODS: Patients who were treated with gemcitabine and S-1 combination therapy in the previous prospective studies were divided into groups of unresectable and recurrent cases. The tumor response, time-to-progression, overall survival, toxicity, and dose intensity were compared between these two groups.
RESULTS: Response rate of the recurrent group was higher than that of the unresectable group (40.0% vs 25.5%; P = 0.34). Median time-to-progression of the recurrent and unresectable groups were 8.7 mo (95%CI), 1.2 mo, not reached) and 5.7 mo (95%CI: 4.0-7.0 mo), respectively (P = 0.14). Median overall survival of the recurrent and the unresectable groups were 16.1 mo (95%CI: 2.0 mo-not reached) and 9.6 mo (95%CI: 7.1-11.7 mo), respectively (P = 0.10). Dose intensities were significantly lower in the recurrent groups (gemcitabine: recurrent group 83.5% vs unresectable group 96.8%; P < 0.01, S-1: Recurrent group 75.9% vs unresectable group 91.8%; P < 0.01). Neutropenia occurred more frequently in recurrent group (recurrent group 90% vs unresectable group 55%; P = 0.04).
CONCLUSION: Not only the efficacy but also the toxicity and dose intensity were significantly different between unresectable and recurrent biliary tract cancer.
Core tip: Many chemotherapeutic studies of advanced biliary tract cancer include both unresectable and recurrent cases. However, the treatment outcomes of these two conditions might be different. We therefore conducted a pooled analysis of two prospective studies to evaluate the differences in the treatment outcomes between the unresectable and recurrent cases in patients with advanced biliary tract cancer patients who received chemotherapy. From our pooled analysis, not only the efficacy but also the toxicity and dose intensity were significantly different between these two conditions. Therefore, it is better to evaluate the unresectable and recurrent cases separately in future prospective studies.