The difference of prognosis between patients with unresectable and recurrent biliary tract cancer (BTC) receiving chemotherapy has not been clarified. In this study, we aimed to compare the prognosis of unresectable BTC with that of recurrent BTC. We also evaluated other prognostic factors of BTC.Methods
This study retrospectively reviewed the data of 403 consecutive patients with pathologically-proven unresectable or recurrent BTC who received palliative chemotherapy from 18 hospitals in Japan between April 2006 and March 2009. The 1-year survival rate and overall survival (OS) and patient characteristics were compared between unresectable and recurrent cases. Univariate and multivariate analyses were carried out to identify the prognostic factors.Results
The 1-year survival rate and OS were significantly better in 192 patients with recurrent BTC than 211 patients with unresectable BTC (1-year survival 57.3% versus 43.1%, P = 0.005; OS 398 days [95% confidence interval (CI) 365–430] versus 323 days [95% CI 282–364], P = 0.004). In baseline characteristics, the proportion of patients who had distant metastasis was significantly greater in recurrent BTC than unresectable BTC (77.1% versus 66.8%, P < 0.001). In contrast, lymph node involvement, biliary intervention and elevated tumor marker levels (CEA and CA19-9) were more common in patients with unresectable BTC (P < 0.001). After the multivariate analysis, unresectable BTC group still demonstrated a significantly worse survival than recurrent BTC group (hazard ratio [HR] 1.44, 95% CI 1.15–1.80, P = 0.002). Other statistically significant prognostic factors were ECOG PS (HR 1.49, 95% CI 1.18–1.87, P < 0.001), metastatic disease (HR 1.53, 95% CI 1.20–1.97, P < 0.001) and higher CEA (>5 ng/ml) (HR 1.71, 95% CI 1.36–2.15, P < 0.001).Conclusions
The status of unresectable/recurrent disease is identified as one of the prognostic factors for patients with BTC receiving chemotherapy and recommended to be used as a stratification factor in the clinical trials.