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Poster Display session 2

1982 - Impact of anatomic site of biliary tract tumour origin and conditional probability of survival (CS): results from 15 prospective advanced first-line clinical trial


29 Sep 2019


Poster Display session 2


Tumour Site

Hepatobiliary Cancers


Mairead McNamara


Annals of Oncology (2019) 30 (suppl_5): v253-v324. 10.1093/annonc/mdz247


M.G. McNamara1, A. Lopes2, H. Wasan3, D. Malka4, D. Goldstein5, J. Shannon6, T. Okusaka7, J.J. Knox8, A.D. Wagner9, T. Andre10, D. Cunningham11, M. Moehler12, L.H. Jensen13, D. Koeberle14, T. Bekaii-Saab15, J.A. Bridgewater16, J.W. Valle17

Author affiliations

  • 1 Medical Oncology, The Christie NHS Foundation Trust/University of Manchester, M20 4BX - Manchester/GB
  • 2 Statistics, CRUK & UCL Cancer Trials Centre, WCIE6BT - London/GB
  • 3 Medical Oncology, Imperial College London - Hammersmith Hospital, W12 0HS - London/GB
  • 4 Internal Medicine, Institute Gustave Roussy, 94805 - Villejuif/FR
  • 5 Medical Oncology, Nelune Cancer Centre, Prince of Wales Hospital; University of New South Wales, 2031 - Randwick/AU
  • 6 Medical Oncology, University of Sydney, NSW 2006 - New South Wales/AU
  • 7 Department Of Hepatobiliary And Pancreatic Oncology, National Cancer Center Hospital, 104-0045 - Tokyo/JP
  • 8 Medical Oncology, Princess Margaret Cancer Centre, M5G2M9 - Toronto/CA
  • 9 Oncology, Centre Hospitalier Universitaire Vaudois - CHUV, 1011 - Lausanne/CH
  • 10 Medical Oncology, Hopital Saint-Antoine, 75571 - Paris/FR
  • 11 Department Of Medicine, The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, SM2 5PT - Sutton/GB
  • 12 Medical Oncology, Universitätsmedizin Mainz, 55131 - Mainz/DE
  • 13 Department Of Oncology, Vejle Sygehus Hospital, 7100 - Vejle/DK
  • 14 Medical Oncology, St. Claraspital AG, 4058 - Basel/CH
  • 15 Medical Oncology, Mayo Clinic Cancer Center, 85054 - Phoenix/US
  • 16 Medical Oncology, UCL Cancer Institute/Paul O'Gorman Building, WC1E 6JD - London/GB
  • 17 Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB


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Abstract 1982


Inclusion of all patients (pts) with advanced biliary tract cancer (aBTC), irrespective of anatomic location, with assessment of overall survival (OS) in prospective trials, is debated. Additionally, outcome is typically described as estimated OS, but CS offers more relevant information once pts have survived for some time; this study assessed the impact of anatomic site of BTC origin and CS.


Pts enrolled into 15 prospective first-line aBTC clinical trials were included. OS was analysed using Cox proportional hazard regression; CS and 95% confidence intervals (CIs) were calculated.


Overall, 1333 pts were included (Jan 97-Dec 13) with a median (med) age of 63 yrs (range 23-85); 46% male; 84% ECOG PS 0/1; 25% locally advanced (LA) stage, 72% metastatic (met), and 3% not reported (NR). Anatomic site of origin was gallbladder (GBC): 385 (29%), cholangiocarcinoma not specified (CCA-NS): 363 (27%), extrahepatic (EHC): 247 (19%), intrahepatic (IHC): 209 (16%), ampulla: 53 (4%) and 76 (6%) NR. Treatment was mono-chemotherapy: 310 (23%), cis/gem combination: 482 (36%), other combination: 520 (39%) and NR: 21 (2%). Med OS: 10.2 mths (95% CI 9.6-10.9). All sites, adjusted for treatment, had decreased risk of death vs GBC: EHC (p<.001), IHC (p<.002), CCA-NS (p<.003), ampulla (p=.003). This reduced risk vs GBC was maintained in those receiving cis/gem combination therapy in EHC (p<.001) and IHC (p<.001), but not in CCA-NS (p=.82) or ampulla (p=.96). Probabilities of surviving an additional yr given survival to 1 (n = 552), 2 (n = 170), 3 (n = 53), and 4 (n = 23) yrs post trial registration were 37%, 45%, 61%, and 63% respectively. For pts who survived 1 yr; those receiving combination therapy vs mono (p=.008), and those with IHC and CCA-NS vs GBC had better CS (both p<.05). Met stage vs LA was associated with shorter CS (p=.002) and ECOG PS and gender had no effect on CS (p>.05, p=.08 respectively).


Pts with GBC have worse OS compared to other anatomic BTC sites. Inclusion of other BTC subtypes, at least, in prospective aBTC clinical trials is justified. Conditional probabilities allow adjusted prognosis prediction for survivors with aBTC.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.


Has not received any funding.


All authors have declared no conflicts of interest.

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