Abstract Introduction Biliary-tract cancers, including intra- and extra-hepatic cholangiocarcinoma and gallbladder carcinoma, are uncommon but highly lethal. They represent roughly 2–3 % of new cancer diagnoses yet contribute about 5 % of cancer-related deaths. Complete surgical resection remains the foundation of curative treatment, whereas the value of peri-operative chemotherapy continues to be debated. Materials and Methods The National Cancer Database (NCDB) was queried for patients diagnosed with non- metastatic biliary tract cancer at age 18 or older between 2004 and 2019. After excluding patients with unknown timing of surgery and chemotherapy, patients who died within 90 days of the most definitive primary site surgery, and patients lost to follow-up, we split the cohort into three groups according to the clinical stage (stage I-III). Then, we evaluated the overall survival (OS) between the different treatment modalities (surgery only, chemotherapy only, adjuvant chemotherapy following surgery, and neoadjuvant chemotherapy followed by surgery) in each group. We studied the OS using Kaplan-Meier estimates and multivariate Cox regression analyses to evaluate factors associated with OS. Results A total of 35,260 patients with non-metastatic biliary tract cancers were included in the analysis, of which 50.4% were females, 83% Caucasians, and 9.5% African Americans. The median age at diagnosis was 70 (range 18-90). 14,757 (41.9%) were stage I, 12,472 (35.4%) stage II, and 8,031 (22.8%) stage III. 7,286 (20.7%) had surgical resection only, 8,144 (23.1%) had chemotherapy only, 6,964 (19.7%) had surgical resection with perioperative chemotherapy, and 12,866 (36.5%) did not receive any treatment. We compared survival between different treatment modalities based on clinical stage. In stage I, patients treated with surgery alone exhibited superior median OS compared with those receiving adjuvant chemotherapy (65.7 vs 50.4 months, P Conclusion Adjuvant and neoadjuvant chemotherapy do not seem to have a survival benefit in early-stage (stage I and II) biliary tract cancers, whereas neoadjuvant chemotherapy tends to improve OS in stage III.
Alhayek et al. (Wed,) studied this question.