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Affiliations
Miloud Azarfane
IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France
Astrid Lièvre
Department of Gastroenterology, CHU Pontchaillou, Rennes 1 University; INSERM U1242, Oncogenesis, Stress and Signaling, Rennes, France
Hélène Senellart
Integrated Center for Oncology, Centre René Gauducheau, Saint Herblain, France
Brigitte Dessomme
Department of Public Health, University Hospital, Nantes, France
Pauline Guillouche
Department of Gastroenterology, Clinique Jules Verne, Nantes, France
Jérémy Meyer
Department of Radiology, University Hospital, Nantes, France
Jaafar Bennouna
IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France
Thimothée Wallenhorst
Department of Gastroenterology, CHU Pontchaillou, Rennes 1 University; INSERM U1242, Oncogenesis, Stress and Signaling, Rennes, France
Maëva Salimon
IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France
Jérôme Gournay
IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France
Tamara Matysiak-Budnik
IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France
Annie Lim
Department of Gastroenterology, Clinique Santé Atlantique, Saint Herblain, France
Julien Edeline
Centre Eugène Marquis, Oncology Department, Rennes, France
Yann Touchefeu
IMAD, Department of Gastroenterology and Digestive Oncology, University Hospital, Nantes, France
How to Cite
Predictive Factors of Chemotherapy Initiation after Biliary Drainage for Advanced Biliary Tract Cancer: A Retrospective Multicenter Study
Abstract
Background and Aims: In unresectable biliary tract cancers, the management of biliary obstruction is often the first step before introduction of chemotherapy. Our aim was to study the predictive factors of chemotherapy initiation after biliary drainage in a series of patients presenting with advanced biliary tract cancer and obstructive jaundice.
Methods: Data of all patients treated for unresectable biliary tract cancer with initial biliary obstruction requiring a drainage in six institutions, from January 2009 to January 2019, were retrospectively collected.
Results: Among 82 patients included in this study (median age 68 years, men 61%), 48 (59%) received chemotherapy. Median overall survival was 4.9 months (0.2-38.7) in the group of patients who did not receive chemotherapy and 12.2 months (1.9-61.0) in chemotherapy group (HR=2.93; 95%CI: 1.6-5.3; p<0.0001). In univariate analysis, younger age, male gender, Eastern Cooperative Oncology Group (ECOG) score ≤2, high albumin level, low C-reactive protein level, and endoscopic drainage were significantly associated with introduction of chemotherapy. In multivariate analysis, only ECOG score ≤2 at diagnosis (HR=70.4; 95%CI: 4.6-1097.6; p=0.002) and male gender (HR=5; 95%CI: 1.5-16.5; p=0.009), were significant independent predictive factors of chemotherapy introduction. Age and bilirubin level at diagnosis were not significant factors in multivariate analysis.
Conclusions: ECOG score ≤ 2 and male gender were the only independent predictive factors of chemotherapy introduction in unresectable biliary tract cancers. Age or initial bilirubin level were not predictors for chemotherapy introduction. These results might help defining the initial therapeutic strategy.