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Systemic adjuvant chemotherapy for cholangiocarcinoma surgery: A systematic review and meta-analysis

Systemic adjuvant chemotherapy for cholangiocarcinoma surgery: A systematic review and meta-analysis
Systemic adjuvant chemotherapy for cholangiocarcinoma surgery: A systematic review and meta-analysis

BACKGROUND: The role of adjuvant therapy for biliary tract cancer is not clearly defined with conflicting results demonstrated across nonrandomized and randomized studies. We report a systematic review and meta-analysis to delineate the effect of AT on overall survival.

METHODS: Eligible studies were identified from MEDLINE, EMBASE, Cochrane and PubMed. Studies comparing adjuvant chemotherapy or chemoradiotherapy after curative-intent surgery with curative surgery only for biliary tract cancer were included. Data pertaining to tumours of the gallbladder and bile ducts were included. The primary outcome assessed was overall survival. Random-effects meta-analysis was performed, as well as pooling of unadjusted Kaplan-Meier curve data.

RESULTS: 35 studies involving 42,917 patients were analysed. There was a significant improvement in overall survival with any adjuvant therapy after surgery compared with surgery only (HR 0.74; 95% CI, 0.67 to 0.83; P < 0.001). There was a significant benefit for adjuvant therapy in those with margin positive surgery (RR, 0.83; 95% CI, 0.77 to 0.91; P < 0.001) and node-positive disease (RR 0.82; 95% CI 0.76 to 0.89; P < 0.001) CONCLUSION: Our review advocates the use of adjuvant therapy in bile duct cancer after curative intent resection. Further prospective studies are needed to determine the optimal regime and timing of an adjuvant approach.

Bile Duct Neoplasms/pathology, Biliary Tract Surgical Procedures, Chemoradiotherapy, Adjuvant, Chemotherapy, Adjuvant, Cholangiocarcinoma/pathology, Gallbladder Neoplasms/pathology, Humans, Lymph Nodes/pathology, Margins of Excision, Neoplasm Staging, Survival Rate
0748-7983
684-693
Rangarajan, Karan
564d1804-d037-4f5a-ba46-580deea13e6c
Simmons, George
110e8a17-5f7b-4405-8381-d43d6e17f271
Manas, Derek
85310c9e-687f-4155-9c0c-766ef079538b
Malik, Hasan
829bca8e-1b58-4a9c-bba2-f6652e3a76ea
Hamady, Zaed Z
545a1c81-276e-4341-a420-aa10aa5d8ca8
Rangarajan, Karan
564d1804-d037-4f5a-ba46-580deea13e6c
Simmons, George
110e8a17-5f7b-4405-8381-d43d6e17f271
Manas, Derek
85310c9e-687f-4155-9c0c-766ef079538b
Malik, Hasan
829bca8e-1b58-4a9c-bba2-f6652e3a76ea
Hamady, Zaed Z
545a1c81-276e-4341-a420-aa10aa5d8ca8

Rangarajan, Karan, Simmons, George, Manas, Derek, Malik, Hasan and Hamady, Zaed Z (2020) Systemic adjuvant chemotherapy for cholangiocarcinoma surgery: A systematic review and meta-analysis. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 46 (4 Pt A), 684-693. (doi:10.1016/j.ejso.2019.11.499).

Record type: Article

Abstract

BACKGROUND: The role of adjuvant therapy for biliary tract cancer is not clearly defined with conflicting results demonstrated across nonrandomized and randomized studies. We report a systematic review and meta-analysis to delineate the effect of AT on overall survival.

METHODS: Eligible studies were identified from MEDLINE, EMBASE, Cochrane and PubMed. Studies comparing adjuvant chemotherapy or chemoradiotherapy after curative-intent surgery with curative surgery only for biliary tract cancer were included. Data pertaining to tumours of the gallbladder and bile ducts were included. The primary outcome assessed was overall survival. Random-effects meta-analysis was performed, as well as pooling of unadjusted Kaplan-Meier curve data.

RESULTS: 35 studies involving 42,917 patients were analysed. There was a significant improvement in overall survival with any adjuvant therapy after surgery compared with surgery only (HR 0.74; 95% CI, 0.67 to 0.83; P < 0.001). There was a significant benefit for adjuvant therapy in those with margin positive surgery (RR, 0.83; 95% CI, 0.77 to 0.91; P < 0.001) and node-positive disease (RR 0.82; 95% CI 0.76 to 0.89; P < 0.001) CONCLUSION: Our review advocates the use of adjuvant therapy in bile duct cancer after curative intent resection. Further prospective studies are needed to determine the optimal regime and timing of an adjuvant approach.

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More information

Accepted/In Press date: 12 November 2019
e-pub ahead of print date: 15 November 2019
Published date: 1 April 2020
Keywords: Bile Duct Neoplasms/pathology, Biliary Tract Surgical Procedures, Chemoradiotherapy, Adjuvant, Chemotherapy, Adjuvant, Cholangiocarcinoma/pathology, Gallbladder Neoplasms/pathology, Humans, Lymph Nodes/pathology, Margins of Excision, Neoplasm Staging, Survival Rate

Identifiers

Local EPrints ID: 455123
URI: http://eprints.soton.ac.uk/id/eprint/455123
ISSN: 0748-7983
PURE UUID: 004206ce-839b-4bda-a40b-69454f8887a9
ORCID for Zaed Z Hamady: ORCID iD orcid.org/0000-0002-4591-5226

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Date deposited: 10 Mar 2022 17:32
Last modified: 16 Jun 2022 02:01

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Contributors

Author: Karan Rangarajan
Author: George Simmons
Author: Derek Manas
Author: Hasan Malik
Author: Zaed Z Hamady ORCID iD

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