129P - Prognostic factors associated with survival in resected biliary tract cancers: A multicentre Italian experience

Background

Biliary tract cancers (BTC) are classified as gallbladder tumours (GBC) and intrahepatic (iCCA) or perihilar and distal extrahepatic cholangiocarcinomas (eCCA). BTC’s 3-year recurrence rate is up to 80%. Capecitabine (CAP) is the standard for adjuvant (adj) chemotherapy (CT). We collected a retrospective multicentre Italian series of resected BTC and analysed the impact of adj CT on survival.

Methods

Main variables were ECOG performance status (PS), pre-surgical (SUR) Ca 19.9 value, type of SUR, site, histology, invasion (T), nodal status (N), vascular invasion (V) resection margins (R), grade (G). Median follow-up (FU) was estimated with reverse Kaplan-Meier (KM) approach; median RFS (RFS) and median overall survival (OS) were estimated by KM method.

Results

We included 142 all-stages BTC resected from 2005 to 2022, adj CT was given to 69 BTC. With median FU of 89 months (mo), overall RFS and OS were 17 and 30 mo. Lower ECOG PS was associated with longer RFS and OS (p<0.001). A pre-SUR Ca19.9 ≤ 29 was associated with longer RFS in iCCA (p=0.001) and OS both in iCCA (p=0.010) and GBC (p=0.019). Lower T was associated with longer RFS (p=0.002) and OS (p<0.001) in iCCA and GBC but not in eCCA. N0 status correlated with longer RFS in iCCA (p<0.001) and OS both in iCCA and GBC (p<0.006). R0 status was associated with longer RFS in eCCA (p=0.043) and GBC (p<0.001), showing longer OS only in GBC only (p<0.001). V0 status was associated with longer RFS (p=0.017) and OS (p=0.009) in iCCA . Adj CT didn’t impact both on RFS (p=0.539) and OS (p=0.978) in the whole cohort. After stratification by site, eCCA showed an advantage given by adj CT on mRFS (p=0.047). Comparing all adj CT, CAP performed better in iCCA, with a mRFS of 19 mo. Multivariate Cox regression analysis for RFS and OS was stratified for iCCA, eCCA and GBC: ECOG PS, R and N status retained significant correlation with RFS (p<0.001, p<0.001 and p=0.034, respectively) and OS (p<0.001, p<0.001, p=0.013, respectively). Pre-SUR Ca19.9 value correlated with OS (p=0.001).

Conclusions

In our series, adj CT didn’t impact on survival except for eCCA. Evaluation of multiple prognostic variables (including T, N, R and V status and pre-SUR Ca19.9) is necessary to identify a subgroup of BTC that can benefit more from adj CT.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.