Multimodality therapy for locoregional extrahepatic cholangiocarcinoma: A population-based analysis

Clifton D. Fuller, Samuel Wang, Mehee Choi, Brian G. Czito, John Cornell, Tania M. Welzel, Katherine A. McGlynn, Join Y. Luh, Charles Thomas

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

BACKGROUND: Although surgical resection is the mainstay of treatment for extrahepatic cholangiocarcinoma, the majority of patients present with advanced disease. Due in part to numeric rarity, the optimum role of radiotherapy (RT) for extrahepatic cholangiocarcinoma, as well as its relative benefit, is an area of debate. The specific aim of this series was to estimate survival for extrahepatic cholangiocarcinoma patients receiving surgery and adjuvant RT using a robust population-based data set. METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) limited-use data set for selected extrahepatic cholangiocarcinoma cases. Lognormal multivariate survival analysis was implemented to estimate survival for patients for treatment cohorts based on extent of surgical intervention and RT. RESULTS: Parametric estimated median survival for patients receiving total/radical resection+RT was 26 months; it was 25 months for total/radical resection alone, 25 months for subtotal/debulking resection+RT, 21 months for subtotal/debulking resection, 12 months for RT alone, and 9 months for those not receiving surgery or RT. Parametric multivariate analysis revealed age, American Joint Committee on Cancer Stage, grade, and surgical/radiation regimen as statistically significant covariates with survival. Surgery alone and adjuvant RT cohorts demonstrated evidence of improved survival compared with no treatment; comparatively, RT alone was associated with survival decrement. Early improvement in survival in adjuvant cohorts was not observed at later time points. CONCLUSIONS: Survival estimates using SEER data suggest an early survival advantage for adjuvant RT for patients with locoregional extrahepatic cholangiocarcinoma. Although future prospective series are needed to confirm these observations, SEER data represent the largest domestic population-based extrahepatic cholangiocarcinoma cohort, and may provide useful baseline survival estimates for future studies.

Original languageEnglish (US)
Pages (from-to)5175-5183
Number of pages9
JournalCancer
Volume115
Issue number22
DOIs
StatePublished - Nov 15 2009

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Cholangiocarcinoma
Survival
Radiotherapy
Population
Adjuvant Radiotherapy
Therapeutics
Epidemiology
Multivariate Analysis
Survival Analysis
Radiation

Keywords

  • Bile duct cancer
  • Cholangiocarcinoma
  • Lognormal survival
  • Radiotherapy
  • Surgery

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Fuller, C. D., Wang, S., Choi, M., Czito, B. G., Cornell, J., Welzel, T. M., ... Thomas, C. (2009). Multimodality therapy for locoregional extrahepatic cholangiocarcinoma: A population-based analysis. Cancer, 115(22), 5175-5183. https://doi.org/10.1002/cncr.24572

Multimodality therapy for locoregional extrahepatic cholangiocarcinoma : A population-based analysis. / Fuller, Clifton D.; Wang, Samuel; Choi, Mehee; Czito, Brian G.; Cornell, John; Welzel, Tania M.; McGlynn, Katherine A.; Luh, Join Y.; Thomas, Charles.

In: Cancer, Vol. 115, No. 22, 15.11.2009, p. 5175-5183.

Research output: Contribution to journalArticle

Fuller, CD, Wang, S, Choi, M, Czito, BG, Cornell, J, Welzel, TM, McGlynn, KA, Luh, JY & Thomas, C 2009, 'Multimodality therapy for locoregional extrahepatic cholangiocarcinoma: A population-based analysis', Cancer, vol. 115, no. 22, pp. 5175-5183. https://doi.org/10.1002/cncr.24572
Fuller CD, Wang S, Choi M, Czito BG, Cornell J, Welzel TM et al. Multimodality therapy for locoregional extrahepatic cholangiocarcinoma: A population-based analysis. Cancer. 2009 Nov 15;115(22):5175-5183. https://doi.org/10.1002/cncr.24572
Fuller, Clifton D. ; Wang, Samuel ; Choi, Mehee ; Czito, Brian G. ; Cornell, John ; Welzel, Tania M. ; McGlynn, Katherine A. ; Luh, Join Y. ; Thomas, Charles. / Multimodality therapy for locoregional extrahepatic cholangiocarcinoma : A population-based analysis. In: Cancer. 2009 ; Vol. 115, No. 22. pp. 5175-5183.
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abstract = "BACKGROUND: Although surgical resection is the mainstay of treatment for extrahepatic cholangiocarcinoma, the majority of patients present with advanced disease. Due in part to numeric rarity, the optimum role of radiotherapy (RT) for extrahepatic cholangiocarcinoma, as well as its relative benefit, is an area of debate. The specific aim of this series was to estimate survival for extrahepatic cholangiocarcinoma patients receiving surgery and adjuvant RT using a robust population-based data set. METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) limited-use data set for selected extrahepatic cholangiocarcinoma cases. Lognormal multivariate survival analysis was implemented to estimate survival for patients for treatment cohorts based on extent of surgical intervention and RT. RESULTS: Parametric estimated median survival for patients receiving total/radical resection+RT was 26 months; it was 25 months for total/radical resection alone, 25 months for subtotal/debulking resection+RT, 21 months for subtotal/debulking resection, 12 months for RT alone, and 9 months for those not receiving surgery or RT. Parametric multivariate analysis revealed age, American Joint Committee on Cancer Stage, grade, and surgical/radiation regimen as statistically significant covariates with survival. Surgery alone and adjuvant RT cohorts demonstrated evidence of improved survival compared with no treatment; comparatively, RT alone was associated with survival decrement. Early improvement in survival in adjuvant cohorts was not observed at later time points. CONCLUSIONS: Survival estimates using SEER data suggest an early survival advantage for adjuvant RT for patients with locoregional extrahepatic cholangiocarcinoma. Although future prospective series are needed to confirm these observations, SEER data represent the largest domestic population-based extrahepatic cholangiocarcinoma cohort, and may provide useful baseline survival estimates for future studies.",
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AU - Cornell, John

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N2 - BACKGROUND: Although surgical resection is the mainstay of treatment for extrahepatic cholangiocarcinoma, the majority of patients present with advanced disease. Due in part to numeric rarity, the optimum role of radiotherapy (RT) for extrahepatic cholangiocarcinoma, as well as its relative benefit, is an area of debate. The specific aim of this series was to estimate survival for extrahepatic cholangiocarcinoma patients receiving surgery and adjuvant RT using a robust population-based data set. METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) limited-use data set for selected extrahepatic cholangiocarcinoma cases. Lognormal multivariate survival analysis was implemented to estimate survival for patients for treatment cohorts based on extent of surgical intervention and RT. RESULTS: Parametric estimated median survival for patients receiving total/radical resection+RT was 26 months; it was 25 months for total/radical resection alone, 25 months for subtotal/debulking resection+RT, 21 months for subtotal/debulking resection, 12 months for RT alone, and 9 months for those not receiving surgery or RT. Parametric multivariate analysis revealed age, American Joint Committee on Cancer Stage, grade, and surgical/radiation regimen as statistically significant covariates with survival. Surgery alone and adjuvant RT cohorts demonstrated evidence of improved survival compared with no treatment; comparatively, RT alone was associated with survival decrement. Early improvement in survival in adjuvant cohorts was not observed at later time points. CONCLUSIONS: Survival estimates using SEER data suggest an early survival advantage for adjuvant RT for patients with locoregional extrahepatic cholangiocarcinoma. Although future prospective series are needed to confirm these observations, SEER data represent the largest domestic population-based extrahepatic cholangiocarcinoma cohort, and may provide useful baseline survival estimates for future studies.

AB - BACKGROUND: Although surgical resection is the mainstay of treatment for extrahepatic cholangiocarcinoma, the majority of patients present with advanced disease. Due in part to numeric rarity, the optimum role of radiotherapy (RT) for extrahepatic cholangiocarcinoma, as well as its relative benefit, is an area of debate. The specific aim of this series was to estimate survival for extrahepatic cholangiocarcinoma patients receiving surgery and adjuvant RT using a robust population-based data set. METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) limited-use data set for selected extrahepatic cholangiocarcinoma cases. Lognormal multivariate survival analysis was implemented to estimate survival for patients for treatment cohorts based on extent of surgical intervention and RT. RESULTS: Parametric estimated median survival for patients receiving total/radical resection+RT was 26 months; it was 25 months for total/radical resection alone, 25 months for subtotal/debulking resection+RT, 21 months for subtotal/debulking resection, 12 months for RT alone, and 9 months for those not receiving surgery or RT. Parametric multivariate analysis revealed age, American Joint Committee on Cancer Stage, grade, and surgical/radiation regimen as statistically significant covariates with survival. Surgery alone and adjuvant RT cohorts demonstrated evidence of improved survival compared with no treatment; comparatively, RT alone was associated with survival decrement. Early improvement in survival in adjuvant cohorts was not observed at later time points. CONCLUSIONS: Survival estimates using SEER data suggest an early survival advantage for adjuvant RT for patients with locoregional extrahepatic cholangiocarcinoma. Although future prospective series are needed to confirm these observations, SEER data represent the largest domestic population-based extrahepatic cholangiocarcinoma cohort, and may provide useful baseline survival estimates for future studies.

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