TY - JOUR
T1 - Treatment and survival of resected and unresected distal cholangiocarcinoma
T2 - a nationwide study
AU - Strijker, Marin
AU - Belkouz, Ali
AU - van der Geest, Lydia G
AU - van Gulik, Thomas M
AU - van Hooft, Jeanin E
AU - de Meijer, Vincent E
AU - Haj Mohammad, Nadia
AU - de Reuver, Philip R
AU - Verheij, Joanne
AU - de Vos-Geelen, Judith
AU - Wilmink, Johanna W
AU - Groot Koerkamp, Bas
AU - Klümpen, Heinz-Josef
AU - Besselink, Marc G
N1 - Funding Information:
This work was supported by the Dutch Cancer Society [grant number UVA2013-5842]. The funding source did not play a role in study design, data collection, analysis/data interpretation, the writing of the manuscript or the decision to submit the article for publication.
Funding Information:
This work was supported by the Dutch Cancer Society [grant number UVA2013-5842]. The funding source did not play a role in study design, data collection, analysis/data interpretation, the writing of the manuscript or the decision to submit the article for publication. The authors thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the Netherlands Cancer Registry.
Publisher Copyright:
© 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2019/7
Y1 - 2019/7
N2 - Background: Population-based data on distal cholangiocarcinoma (DCC) from the Western world are not available, albeit essential to identify areas for improvement. This study investigated the incidence, treatment and outcomes, including time trends and predictors for survival, in a nationwide cohort of DCC. Methods: This is a retrospective cohort study of patients diagnosed with DCC (2009–2016) derived from the Netherlands Cancer Registry. Overall survival (OS) and its predictors were analyzed using Kaplan–Meier and Cox regression analysis. Time trends (2009–2012 versus 2013–2016) were assessed. Results: Overall, 1338 patients with DCC were included, with 1-, 3- and 5-year OS of 46%, 18%, and 11%. Incidence of DCC was 0.55–0.90 per 100.000 per year. Median OS was 10.4 months across all stages; 21.9 months for resected (n = 620, 46.3%), 6.7 months for unresected nonmetastatic (n = 445, 33.3%), and 3.6 months for metastatic DCC (n = 273, 20.4%) (p <.001). After resection, 30-day mortality was 4.8% and 90-day mortality 7.7%. Patients with metastatic DCC who received chemotherapy (n = 78, 28.6%) had a median OS of 8.2 versus 2.8 months for those not treated (p <.001). Over time, resection rates (53.6% to 61.7%, p =.008) and use of palliative chemotherapy in metastatic DCC (22.3% to 32.9%, p =.05) increased, without improvement in OS (10.3 vs 10.6 months, p =.55). Independent poor prognostic factors for OS in resected disease were increasing age, pT3/T4 stage, higher lymph node ratio, poor differentiation, and R1 resection. Conclusions: In a nationwide cohort of DCC, resection rates and the use of chemotherapy increased whereas OS remained stable at 10.4 months.
AB - Background: Population-based data on distal cholangiocarcinoma (DCC) from the Western world are not available, albeit essential to identify areas for improvement. This study investigated the incidence, treatment and outcomes, including time trends and predictors for survival, in a nationwide cohort of DCC. Methods: This is a retrospective cohort study of patients diagnosed with DCC (2009–2016) derived from the Netherlands Cancer Registry. Overall survival (OS) and its predictors were analyzed using Kaplan–Meier and Cox regression analysis. Time trends (2009–2012 versus 2013–2016) were assessed. Results: Overall, 1338 patients with DCC were included, with 1-, 3- and 5-year OS of 46%, 18%, and 11%. Incidence of DCC was 0.55–0.90 per 100.000 per year. Median OS was 10.4 months across all stages; 21.9 months for resected (n = 620, 46.3%), 6.7 months for unresected nonmetastatic (n = 445, 33.3%), and 3.6 months for metastatic DCC (n = 273, 20.4%) (p <.001). After resection, 30-day mortality was 4.8% and 90-day mortality 7.7%. Patients with metastatic DCC who received chemotherapy (n = 78, 28.6%) had a median OS of 8.2 versus 2.8 months for those not treated (p <.001). Over time, resection rates (53.6% to 61.7%, p =.008) and use of palliative chemotherapy in metastatic DCC (22.3% to 32.9%, p =.05) increased, without improvement in OS (10.3 vs 10.6 months, p =.55). Independent poor prognostic factors for OS in resected disease were increasing age, pT3/T4 stage, higher lymph node ratio, poor differentiation, and R1 resection. Conclusions: In a nationwide cohort of DCC, resection rates and the use of chemotherapy increased whereas OS remained stable at 10.4 months.
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Bile Duct Neoplasms/mortality
KW - Bile Ducts, Intrahepatic/pathology
KW - Chemotherapy, Adjuvant/methods
KW - Cholangiocarcinoma/epidemiology
KW - Female
KW - Hospital Mortality
KW - Humans
KW - Incidence
KW - Kaplan-Meier Estimate
KW - Male
KW - Margins of Excision
KW - Middle Aged
KW - Neoplasm Staging
KW - Netherlands/epidemiology
KW - Palliative Care/methods
KW - Pancreaticoduodenectomy
KW - Prognosis
KW - Registries/statistics & numerical data
KW - Retrospective Studies
KW - Time Factors
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85063454221&partnerID=8YFLogxK
U2 - 10.1080/0284186X.2019.1590634
DO - 10.1080/0284186X.2019.1590634
M3 - Article
C2 - 30907207
SN - 0284-186X
VL - 58
SP - 1048
EP - 1055
JO - Acta Oncologica
JF - Acta Oncologica
IS - 7
ER -