Neoadjuvant Therapy for Extrahepatic Biliary Tract Cancer: A Propensity Score-Matched Survival Analysis

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Surgery is the primary curative treatment for extrahepatic biliary tract cancer (EBTC), but high recurrence rates and poor prognosis persist.
• The comparative effectiveness of neoadjuvant therapy (NAT) versus upfront surgery (US) for EBTC remains incompletely understood.

Purpose of the Study:

• To investigate the trends in NAT utilization for EBTC.
• To compare the prognostic impact of NAT versus US in EBTC patients using propensity score-matched analysis.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results (SEER) database (2006-2017) to identify EBTC patients (gallbladder cancer and extrahepatic cholangiocarcinoma) who underwent surgery.
• Conducted propensity score-matched (PSM) analysis to compare overall survival (OS) and cancer-specific survival (CSS) between NAT and US groups.
• Performed subgroup analysis to identify patient populations that may benefit from NAT.

Main Results:

• Only 1.6% of 6582 EBTC patients received NAT, with increasing utilization over time.
• NAT was associated with a lower lymph node ratio in patients with lymph node metastasis (0.18 vs. 0.40, p < 0.01).
• After PSM, no significant differences in 5-year OS (24.0% vs. 24.6%) or CSS (38.0% vs. 36.1%) were observed between NAT and US groups.
• Subgroup analysis revealed improved OS (HR 0.65) and CSS (HR 0.62) for advanced-stage (III-IVA) EBTC patients treated with NAT.

Conclusions:

• Neoadjuvant therapy (NAT) does not offer an overall survival benefit for all patients undergoing surgery for extrahepatic biliary tract cancer (EBTC).
• Patients with advanced-stage EBTC (stages III-IVA) demonstrated improved overall survival and cancer-specific survival when treated with NAT.
• An individualized approach to neoadjuvant therapy (NAT) selection for EBTC patients may enhance survival outcomes.