Failure to administer multimodality therapy leads to sub-optimal outcomes for patients with node-positive biliary tract cancers in the United States

Adam C. Sheka, Ariella Altman, Schelomo Marmor, Jane Y.C. Hui, Jason W. Denbo, Jacob S. Ankeny, Eric H. Jensen

Research output: Contribution to journalArticlepeer-review


Background: Lymph node-positive biliary tract cancers have poor overall survival. Surgical resection followed by systemic chemotherapy is the mainstay of treatment. We sought to assess the delivery of multimodality therapy in the United States. Methods: The Surveillance, Epidemiology, and End Results program database was used to identify patients with node-positive biliary tract cancers without distant metastases from 2000 to 2014. Patients were stratified by disease subtype (gallbladder cancer, intrahepatic, extrahepatic, or hilar cholangiocarcinoma) and treatment received (surgery alone, chemotherapy alone, or surgery + chemotherapy). Survival was analyzed using the Kaplan-Meier method and Cox proportional hazard modeling. Results: A total of 3226 patients with node-positive biliary tract cancers were identified. Of 2837 patients who underwent surgical resection, 1386 (49%) received no systemic chemotherapy following surgery, while 1451 (51%) received surgery + chemotherapy. A total of 389 patients (12%) received chemotherapy alone. Median overall survival was longer for patients who underwent surgery + chemotherapy (19 months, p < 0.0001). There was no difference in survival for those who received surgery alone versus chemotherapy alone (10 months for both, p = NS). Receipt of surgery + chemotherapy was independently associated with survival on Cox proportional hazard ratio modeling compared to surgery alone (HR for mortality 1.71, 95% CI 1.56–1.87, p < 0.0001) or chemotherapy alone (HR 1.68, 95% CI 1.46–1.92, p < 0.0001). These trends were consistent across all disease subtypes. Discussion: Optimal survival for node-positive biliary tract cancers depends on multimodality therapy. Following surgery, a substantial proportion of patients do not receive guideline recommended adjuvant therapy.

Original languageEnglish (US)
Pages (from-to)298-303
Number of pages6
JournalSurgical Oncology
StatePublished - Sep 2020

Bibliographical note

Funding Information:
Ariella Altman is in part supported by the Institute of Basic and Applied Research in Surgery and the VFW grant at the University of Minnesota .

Publisher Copyright:
© 2020

Copyright 2020 Elsevier B.V., All rights reserved.


  • Biliary tract cancers
  • Cancer outcomes
  • Extrahepatic cholangiocarcinoma
  • Gallbladder cancer
  • Intrahepatic cholangiocarcinoma

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