Adjuvant Chemotherapy and Outcomes in Older Adult Patients With Biliary Tract Cancer

The association of adjuvant chemotherapy (AC) with survival in the general population of patients with resected biliary tract cancer (BTC) remains controversial. As such, the role of this treatment in the treatment of older adult patients (aged ≥70 years) needs to be evaluated. To describe the patte...

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Bibliographic Details
Published in:JAMA network open 2024-01, Vol.7 (1), p.e2351502
Main Authors: Gbolahan, Olumide B, Zhi, Xiaojie, Liu, Yuan, Shah, Mihir M, Kooby, David A, Alese, Olatunji B
Format: Article
Language:English
Subjects:
Aged
Biliary Tract Neoplasms - drug therapy
Biliary Tract Neoplasms - surgery
Cancer
Chemotherapy
Chemotherapy, Adjuvant
Cholangiocarcinoma
Cohort analysis
Cohort Studies
Female
Humans
Male
Propensity Score
Retrospective Studies
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Summary:The association of adjuvant chemotherapy (AC) with survival in the general population of patients with resected biliary tract cancer (BTC) remains controversial. As such, the role of this treatment in the treatment of older adult patients (aged ≥70 years) needs to be evaluated. To describe the patterns of use of AC and compare survival outcomes of AC and observation in older adult patients following resection of BTC. This retrospective cohort study included 8091 older adult patients with resected BTC with data available in the National Cancer Database from January 1, 2004, to December 31, 2019. Patients were divided into 2 cohorts: AC and observation. The AC cohort was subdivided into single-agent and multiagent AC treatment. Adjuvant chemotherapy vs observation following BTC resection. The primary outcome was overall survival (OS) of patients who received AC compared with observation following resection of BTC as evaluated using Kaplan-Meier estimates and multivariable Cox proportional hazards regression models. Inverse probability of treatment weighting and propensity score matching were performed to address indication bias. Between 2004 and 2019, of 8091 older adult patients with resected BTC identified (median [range] age, 77 [70-90] years; 5136 women [63.5%]; 2955 men [36.5%]), only one-third (2632 [32.5%]) received AC. There was an increase in the use of AC across the study period from 20.7% (n = 495) in 2004 to 2009 to 41.2% (n = 856) in 2016 to 2019. Age 80 years or older (odds ratio, 0.29; 95% CI, 0.25-0.33; P 
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2023.51502