Cancer Research and Treatment

Original Article

Chemotherapy versus Best Supportive Care in Advanced Biliary Tract Carcinoma: A Multi-institutional Propensity Score Matching Analysis: Jun Ho Ji, Young Saing Kim, Inkeun Park, Soon Il Lee, Rock Bum Kim, Joon Oh Park, Sung Yong Oh, In Gyu Hwang, Joung-Soon Jang, Haa-Na Song, Jung-Hun Kang; Cancer Res Treat. 2018;50(3):791-800. Published online August 23, 2017; DOI: https://doi.org/10.4143/crt.2017.044

Purpose
Although chemotherapy is recommended by various guidelines for advanced biliary tract cancer (BTC), the evidence supporting its use over best supportive care (BSC) is limited. The aim of this study was to investigate the survival benefit of chemotherapy over that of BSC in advanced BTC patients.
Materials and Methods
Advanced BTC patientswith a good performance status (Eastern CooperativeOncologyGroup [ECOG] 0-2) were eligible for the study. Data were retrospectively collected from four tertiary cancer centers and analyzed using propensity score matching (PSM). Of the 604 patients enrolled, 206 received BSC and 398 received chemotherapy. PSM analysis was performed using the following variables: age, ECOG status, carcinoembryonic antigen (CEA) level, white blood cell level, albumin level, total bilirubin level, and aspartate aminotransferase level. The sample size of each group was 164 patients after PSM. Median survival was compared between the two groups by using the Kaplan-Meier method, and prognostic factors were investigated using Cox proportional regression analysis.
Results
In post-PSM analysis, the respective median survival for the chemotherapy and BSC groups was dependent on the following prognostic factors: total population, 12.0 months vs. 7.5 months (p=0.001); locally advanced disease, 16.7 months vs. 13.4 months (p=0.490); cancer antigen 19-9 ≤ 100 IU/mL, 12.7 months vs. 10.6 months (p=0.330); and CEA ≤ 3.4 ng/mL, 17.1 months vs. 10.6 months (p=0.052).
Conclusion
Chemotherapy improved overall survival of patients with advanced BTC who had a good performance status. However, this survival benefit was not observed in BTC patients with locally advanced disease or with lower tumor marker. Individualized approach is needed for initiation of palliative chemotherapy in advanced BTC.

Citations

Citations to this article as recorded by

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma
Faisal Saud Dar, Zaigham Abbas, Irfan Ahmed, Muhammad Atique, Usman Iqbal Aujla, Muhammad Azeemuddin, Zeba Aziz, Abu Bakar Hafeez Bhatti, Tariq Ali Bangash, Amna Subhan Butt, Osama Tariq Butt, Abdul Wahab Dogar, Javed Iqbal Farooqi, Faisal Hanif, Jahanzai
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Treatment patterns and survival in older adults with unresected nonmetastatic biliary tract cancers
Ali Belkouz, Elise de Savornin Lohman, Jyothi R. Thumma, Bas Groot Koerkamp, Philip R. de Reuver, Martijn G.H. van Oijen, Cornelis J.A. Punt, Hari Nathan, Heinz-Josef Klümpen
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Main causes of death in advanced biliary tract cancer
Kana Kimura‐Seto, Yasushi Kojima, Shiori Komori, Yuya Hisada, Yuki Otake, Yuka Yanai, Akiko Saito, Naoki Akazawa, Yasuo Tanaka, Chizu Yokoi, Mikio Yanase, Junichi Akiyama, Natsuyo Yamamoto, Kazuhiko Yamada
Cancer Medicine.2023; 12(9): 10889. CrossRef
A Systematised Literature Review of Real-World Treatment Patterns and Outcomes in Unresectable Advanced or Metastatic Biliary Tract Cancer
Vivian Peirce, Michael Paskow, Lei Qin, Ruby Dadzie, Maria Rapoport, Samantha Prince, Sukhvinder Johal
Targeted Oncology.2023; 18(6): 837. CrossRef
Short- and Long-Term Survival of Metastatic Biliary Tract Cancer in the United States From 2000 to 2018
Van Nghiem, Sarah Wood, Rekha Ramachandran, Grant Williams, Darryl Outlaw, Ravikumar Paluri, Young-il Kim, Olumide Gbolahan
Cancer Control.2023;[Epub] CrossRef
Anticancer Drugs Compared to No Anticancer Drugs in Patients with Advanced Hepatobiliary Cancer: A Mapping Review and Evidence Gap Map
Carolina Requeijo, Javier Bracchiglione, Nicolás Meza, Roberto Acosta-Dighero, Josefina Salazar, Marilina Santero, Adriana-G Meade, María Jesús Quintana, Gerardo Rodríguez-Grijalva, Anna Selva, Ivan Solà, Gerard Urrútia, Xavier Bonfill Cosp
Clinical Epidemiology.2023; Volume 15: 1069. CrossRef

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Meta-Analysis

Adjuvant Chemotherapy for Advanced Gastric Cancer in Elderly and Non-elderly Patients: Meta-Analysis of Randomized Controlled Trials: Seong-Hwan Chang, Soo-Nyung Kim, Hye Jung Choi, Misuk Park, Rock Bum Kim, Se-Il Go, Won Sup Lee; Cancer Res Treat. 2017;49(1):263-273. Published online July 5, 2016; DOI: https://doi.org/10.4143/crt.2016.054

Abstract PDF PubReader ePub

Purpose
This study evaluated the benefits of adjuvant chemotherapy on elderly patients with advanced gastric cancer (AGC) using meta-analysis of well-designed randomized controlled clinical studies.
Materials and Methods
PubMed, Embase, and Cochrane were searched to retrieve clinical studies evaluating the benefits of adjuvant chemotherapy in the elderly with AGC. Hazards ratios (HRs) with 95% confidence intervals (CIs) were pooled across studies using a fixed-effects model.
Results
Two studies were included in this meta-analysis to estimate HR for the overall survival (OS), and relapse-free survival (RFS) between adjuvant chemotherapy and surgery in elderly and non-elderly patients. HR for OS in the elderly and non-elderly was 0.745 (95% CI, 0.552 to 1.006, p=0.055) and 0.636 (95% CI, 0.522 to 0.776; p < 0.001), respectively, which showed no heterogeneity regarding HR between the two groups (p_interaction=0.389). HR for RFS in the elderly and non-elderly was 0.613 (95% CI, 0.466 to 0.806; p < 0.001) and 0.633 (95% CI, 0.533 to 0.753; p < 0.001), respectively (p_interaction=0.846).
Conclusion
Meta-analysis suggests that the benefit of adjuvant chemotherapy to the elderly is not big enough to reach statistical significance while the HR for OS is less than 1 (0.745) and no heterogeneity are observed regarding the HR between the elderly and non-elderly patients.

Citations

Citations to this article as recorded by

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Sotiris Loizides, Demetris Papamichael
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Ya Li, Yanjun Chu, Ruifeng Song, Feng Xu
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Deng-Feng Ren, Fang-Chao Zheng, Jun-Hui Zhao, Guo-Shuang Shen, Raees Ahmad, Shui-Sheng Zhang, Yu Zhang, Jie Kan, Li Dong, Zi-Yi Wang, Fu-Xing Zhao, Jiu-Da Zhao
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Original Article

CD44 Variant 9 Serves as a Poor Prognostic Marker in Early Gastric Cancer, But Not in Advanced Gastric Cancer: Se-Il Go, Gyung Hyuck Ko, Won Sup Lee, Rock Bum Kim, Jeong-Hee Lee, Sang-Ho Jeong, Young-Joon Lee, Soon Chan Hong, Woo Song Ha; Cancer Res Treat. 2016;48(1):142-152. Published online March 17, 2015; DOI: https://doi.org/10.4143/crt.2014.227

Abstract PDF PubReader ePub

Purpose
The present study is to investigate the significance of CD44 variant 9 (CD44v9) expression as a biomarker in primary gastric cancer.
Materials and Methods
With various gastric tissues, we performed immunohistochemical staining for CD44v9.
Results
The positive expression rates for CD44v9 in tumor, including adenoma, early gastric cancer (EGC), and advanced gastric cancer (AGC), were higher than those in non-tumor tissues (p = 0.003). In addition, the higher expression for CD44v9 was observed as the tissue becomes malignant. In the analysis of 333 gastric cancer tissues, we found that positive expression rates for CD44v9 were higher in the intestinal type or well differentiated gastric cancer than in the diffuse type or poorly differentiated gastric cancer. Interestingly, the positive expression indicated poor prognosis in EGC (5-YSR in stage I, 81.7% vs 95.2%; p = 0.013), but not in AGC (5-YSR in stage II, 66.9% vs 62.2%; p = 0.821, 5-YSR in stage III, 34.5% vs 32.0%; p = 0.929). Moreover, strong positive expression (3+) showed a trend suggesting worse prognosis only in EGC, and it appeared to be associated with lymph node metastasis.
Conclusion
This study suggests that CD44v9 may be a good biomarker for prognosis prediction and for chemoprevention or biomarker-driven therapies only for EGC.

Citations

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