P-138 Biliary tract cancers: epidemiology and prognosis

Abstract

Introduction: Biliary tract carcinomas are rare tumors with poor prognosis. Few data are available on epidemiology characteristics in Tunisia. We conducted a retrospective study enrolling 17 patients diagnosed with a cholangiocarcinoma (CCA) including intrahepatic CCA, extrahepatic CCA and gallbladder carcinoma (GBC) from 2012 to 2014 in the SOMA department. We identified the clinical, histological, therapeutic features and prognostic factors of these patients. Methods: We conducted a retrospective study from 2012 to 2014, concerning enrolling patients presenting a cholangiocarcinoma (CCA), intrahepatic and extrahepatic CCA and gallbladder carcinoma (GBC). We analyzed their clinical, histological, therapeutic features and prognostic factors. Results: We collected 17 patients (9M/8F) having a median age of 59 years [39-72] with a history of alcohol consumption in 20% of patients. They consulted for abdominal pain (70%), weight loss (58%) or jaundice in 48% of cases. Most of patients had a good PS (0-1) and an average BMI of 28.8 kg/m2. Primary tumor site was GB in 41% of cases, low bile duct in 23.5% and the hepatic hilum in 35.5% of cases. Initial mean serum levels of CEA and CA 19-9 were respectively 153.5 U/l and 619 U/l. Tumors were locally advanced and/or metastatic in 70% of cases. All patients received palliative CT; only 1st in 50% of cases by GEMOX (9 cases), GEMCIS (1 case), folforinox (1 case) and gemcitabine in 1 case. Patients remaining with a good PS (0-1) were treated with 2nd or 3rd line of CT in 25% in both cases, by gemcitabine, capecitabine, irinotecan and paclitaxel. Most of the patients receiving palliative CT progressed (75%) after a median time of 4 months. The median survival for the whole population was 9 months. Five patients were treated with curative surgery including a lymph node dissection and 3 patients of them received adjuvant CT based on gemcitabine plus oxaliplatin or cisplatin. The median survival of these patients was 10 months. Conclusion: CCA is subject to delayed diagnosis at locally advanced or metastatic stages, explaining their poor prognosis. Treatment is based on palliative CT with gemcitabine and cisplatin. Identification of more fine predictive and prognostic factors is the key to improve the management of these tumors.