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Abstract
Purpose: Despite frequent use in the clinical setting, especially for patients with high-risk factors for relapse, the role of adjuvant treatment has not been clarified in nonhilar extrahepatic bile duct cancer (NH-EHBDC). The goal of this study is to identify the role of adjuvant chemoradiotherapy (CRT) in NH-EHBDC patients after radical surgery.

Methods and materials: Patients with NH-EHBDC who underwent radical surgery from July 2007 to December 2018 were reviewed retrospectively. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Subgroup analyses were performed to further identify the role of adjuvant CRT.

Results: Three hundred twenty-eight patients were accrued. At a median follow-up of 37.1 months (range, 1.0-144.2 months), the 3-year LRRFS, DMFS, DFS, and OS were 63.4%, 59.0%, 53.2%, and 67.5%, respectively. In multivariate analysis, adjuvant CRT was an independent prognostic factor for LRRFS, DMFS, DFS, and OS (P < .05). For patients with nodal involvement, pT3 stage, tumor size ≥ 5 cm, poorly differentiated tumor, and R1 resection, adjuvant CRT significantly improved DFS (P < .05).

Conclusions: In patients with NH-EHBDC, adjuvant CRT significantly improved LRRFS and DFS. For patients with risk factors such as nodal involvement, pT3 stage, poorly differentiated tumor, tumor size ≥ 5 cm, or R1 resection, adjuvant CRT might contribute to improve treatment outcomes.

Affiliations

Won Ick Chang  1 , Byoung Hyuck Kim  2 , Hyun-Cheol Kang  1 , Kyubo Kim  3 , Kyung-Hun Lee  4 , Do-Youn Oh  4 , Hongbeom Kim  5 , Wooil Kwon  5 , Jin-Young Jang  5 , Eui Kyu Chie  6
1 Department of Radiation Oncology, Seoul National University College of Medicine.
2 Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University, Boramae Medical Center.
3 Department of Radiation Oncology, Ewha Womans University College of Medicine.
4 Department of Internal Medicine, Seoul National University College of Medicine.
5 Department of Surgery, Seoul National University College of Medicine.
6 Department of Radiation Oncology, Seoul National University College of Medicine; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea. Electronic address: ekchie93@snu.ac.kr.