Postoperative adjuvant chemotherapy and chemoimmunotherapy after radical resection for biliary tract cancer: a...

The prognosis of biliary tract cancers (BTC) after radical resection is still unsatisfactory. However, the clinical value of adjuvant therapy remains controversial. This retrospective study aimed to evaluate the clinical value of adjuvant chemotherapy and adjuvant chemoimmunotherapy in patients with BTC after radical resection.

Data from BTC patients who underwent radical resection were retrospectively obtained from Hunan Provincial People's Hospital between January 2020 and July 2024. Patients were divided into observation group, adjuvant chemotherapy group, and adjuvant chemoimmunotherapy group according to the treatment received by the patient after surgery. Survival curves were determined by the Kaplan-Meier method. The COX proportional hazards regression model was used to determine independent prognostic risk factors. The adjuvant chemotherapy group and adjuvant chemoimmunotherapy group were analyzed by PSM at a 1:1 ratio.

A total of 219 patients with BTC were reenrolled in this study, with 108 cases of iCCA, 39 cases of pCCA, 15 cases of DCCA, and 57 cases of GBC. Eighty-seven patients (39.73%) received surgery alone, 69 patients (31.51%) received postoperative adjuvant chemotherapy, and 63 patients (28.77%) received postoperative adjuvant chemoimmunotherapy. There was no different significance for median recurrence-free survival (RFS) in the 3 groups (13.20 vs 20.40 vs 19.68 months; P = .195). The median overall survival (OS) was the longest in the chemoimmunotherapy group (29.20 vs 31.5 vs 43.27 months; P = .003). After propensity score matching (PSM), there was no difference in median RFS in the 2 adjuvant groups (22.03 vs 19.87 months; P = .350). The median OS was longer in the chemoimmunotherapy group (45.27 vs 29.40 months; P = .015). In Cox analysis, lymph node metastasis, differentiation, and adjuvant treatment were the independent predictors of OS in patients with BTC. The most common adverse events were of any grade of hematologic toxicity. No drug-related deaths occurred in either group.

The safety of chemoimmunotherapy was acceptable and could significantly prolong the overall survival of BTC. These data provided a basis for an additional prospective clinical trial to evaluate the efficacy of chemoimmunotherapy in adjuvant therapy for BTC.