Topic: Adjuvant therapy - retrospective study - GI ASCO 2013

Author(s):

Kosin Wirasorn, Thundon Ngamprasertchai, Narong Khantikaew, Ake Pakkhem, Piti Ungarereevittaya, Jarin Jindaprasert, Aumkhae Sookprasert; Department of Medicine, Khon Kaen University, Khon Kaen, Thailand; Department of Surgery, Khon Kaen University, Khon Kaen, Thailand; Department of Pathology, Khon Kaen University, Khon Kaen, Thailand


Background: Cholangiocarcinoma patients usually have poor treatment outcome and high mortality rate. The role of adjuvant chemotherapy is controversy. Our study aimed to evaluate benefits of adjuvant chemotherapy in resectable cholangiocarcinoma patients. Methods: A retrospective study included 263 patients who underwent curative resection in Srinakarind university hospital. These patients had pathological report with clear margin (R0) or microscopic margin (R1). Results: There were 138 patients received adjuvant chemotherapy. This group had significantly lower mean age than patients without chemotherapy (57.7 ± 8.5 vs. 60.4 ± 9.0 years, p = 0.01). Level of serum albumin above 3g/dL was more common in adjuvant chemotherapy group than another one (87.7% vs. 79.2%, p = 0.04). Patients who received adjuvant chemotherapy had significantly longer overall median survival time (21.6 vs. 13.4 months, p = 0.01). Patients with combination of gemictabine and capecitabine regimen had the longest survival time (median overall survival time of gemcitabine and capecitabine 31.5, 5-FU and mitomycin 17.3, 5-FU alone 22.2, capecitabine alone 21.6, and gemcitabine alone 7.9 months, p = 0.02). Benefits of adjuvant chemotherapy were likely to be found in patients who had high risk features, i.e. high level of CEA, high level of CA19-9, advanced stage, T4 stage, nodal involvement and R1 margin. Conclusions: Adjuvant chemotherapy may significantly prolong survival time in resectable cholangiocarcinoma patients, particularly the high risk group.

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Re: Adjuvant therapy - retrospective study - GI ASCO 2013

Hi,
I think the study is bias in the way that the group which received adjuvant chemotherapy is younger and in relatively better condition( albumin level>3 ) than the control group. Another short coming is that the study,base on this abstract,did not provide the distinction of the three types of CCA that we know of. Therefore the overall survival may be too optimistic . I may be wrong since I am not a doctor but a patient. But the conclusion may be valid without the word " significantly".
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.