Adjuvant S-1 vs gemcitabine for node-positive perihilar cholangiocarcinoma: A propensity score-adjusted analysis.

Abstract

BACKGROUND:

The efficacy of adjuvant chemotherapy for biliary cancers remains controversial because of conflicting results from previous phase 3 studies that used different key drugs and enrolled patients with heterogeneous tumor sites and disease stages. Fluoropyrimidine seems more beneficial than gemcitabine (GEM) combination regimens in the adjuvant setting; however, data comparing the survival benefit between GEM- and fluoropyrimidine-based regimens are lacking.

METHODS:

Patients who underwent resection for node-positive perihilar cholangiocarcinoma were included. The patients who underwent adjuvant chemotherapy were divided into the S-1 and GEM groups according to the regimen. The recurrence-free survival (RFS) and the overall survival (OS) were compared between the groups and adjusted with propensity scores generated from 14 potentially confounding clinicopathological factors.

RESULTS:

In total, 186 patients (Surgery alone, n = 71; S-1, n = 60; GEM, n = 55) were included. The S-1 and GEM completion rates were 75% and 65%, respectively. Among the patients who underwent adjuvant therapy, the RFS was longer in the S-1 group patients than the GEM group patients (median, 24.4 months vs 14.9 months; P = .044) whereas the OS was not significantly different between the groups (median, 48.5 months vs 35.0 months; P = .324). After propensity score adjustment, the differences in RFS and OS between the groups were more evident (HR: 2.696, 95% CI: 1.739-4.180 P < .001; HR: 1.988, 95% CI: 1.221-3.238, P < .001, respectively).

CONCLUSIONS:

Compared with adjuvant GEM monotherapy, adjuvant S-1 monotherapy may improve survival in node-positive perihilar cholangiocarcinoma patients.

• Authors: Daigoro Takahashi, Takashi Mizuno, Yukihiro Yokoyama, Tsuyoshi Igami, Junpei Yamaguchi, Shunsuke Onoe, Nobuyuki Watanabe, Osamu Maeda, Masahiko Ando, Tomoki Ebata
• Journal: Journal of hepato-biliary-pancreatic sciences (J Hepatobiliary Pancreat Sci) Vol. 28 Issue 9 Pg. 716-726 (Sep 2021) ISSN: 1868-6982 [Electronic] Japan
• PMID: 34087061 (Publication Type: Journal Article)
• Copyright: © 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Chemical References

• Deoxycytidine
• Gemcitabine

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bile Duct Neoplasms (drug therapy, surgery)
• Chemotherapy, Adjuvant
• Cholangiocarcinoma (drug therapy)
• Deoxycytidine (analogs & derivatives)
• Humans
• Klatskin Tumor (drug therapy, surgery)
• Propensity Score
• Retrospective Studies
• Gemcitabine