Natural History of Untreated Patients Who Had Metastatic Biliary Tract Cancer (Btc) with Good Performance Status (Ps)

Abstract

Background: Although gemcitabine-based chemotherapy is widely recommended to the patients with metastatic biliary tract cancer, the strong evidence for clinical benefit of chemotherapy is far from enough. The natural course of BTC patients with good PS who are usually for chemotherapy was rarely known. Methods: We retrospectively reviewed metastatic or locally advanced BTC patients seen between January 2005 and September 2013 at six cancer centers. Patients were eligible if they had good PS (ECOG 0-2), no history of surgery, chemotherapy, radiotherapy or any treatment for cancer. Primary object was to evaluate survival time and secondary objectives were to examine survival difference among other variables. Results: Of the 1,677 screened patients, a total of 1,612 met the eligibility criteria. Median overall survival (OS) was 7.1 months and Patients with metastatic BTC had a poor prognosis with median 6.2 months and locally advanced BTC had a good prognosis with 13,0 months. (P=0.001) Baseline CA 19-9 elevation (100U/mL) also showed poor survival. (6.0 months vs 10.6 months, P=0.001) The better performance status tended to the longer survival time, but there was not statistically significant difference. (P=0.101). The median surival times of other variables show no statistically significant differences. Conclusions: Metastatic BTC cancer with good PS showed modest survival without any treatment for primary cancer. Furthermore, subgroup analysis showed that patients with normal CA19-9 level or locally advanced status had favorable survival. Further studies comparing chemotherapeutic effect with BSC in patients with unresectable BTC are warranted.