A prognostic model in patients with advanced biliary tract cancer receiving first-line chemotherapy

Authors

  • Roberto Filippi Department of Oncology, University of Turin, Torino, Italy; Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy; Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
  • Francesco Montagnani Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, Italy
  • Pasquale Lombardi Department of Oncology, University of Turin, Torino, Italy; Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
  • Lorenzo Fornaro Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
  • Giuseppe Aprile Department of Oncology, University Hospital of Udine, Udine, Italy; Department of Oncology, San Bortolo General Hospital, AULSS8, Vicenza, Italy
  • Andrea Casadei-Gardini Medical Oncology Unit, IRCCS Cancer Institute “Giovanni Paolo II”, Bari, Italy; Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari, Italy
  • Luca Faloppi Medical Oncology Unit, Macerata General Hospital, Macerata, Italy
  • Andrea Palloni Department of Oncology and Haematology, University Hospital of Modena, Italy
  • Maria Antonietta Satolli Department of Oncology, University of Turin, Torino, Italy; Centro Oncologico Ematologico Subalpino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
  • Mario Scartozzi Department of Medical Oncology, University Hospital, Cagliari, Italy
  • Fabrizio Citarella Department of Medical Oncology, Campus Bio-Medico University, Roma, Italy
  • Stefania Eufemia Lutrino Department of Oncology, Ospedale Vito Fazzi, Lecce, Italy
  • Caterina Vivaldi Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
  • Nicola Silvestris Medical Oncology Unit, IRCCS Cancer Institute “Giovanni Paolo II”, Bari, Italy; Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari, Italy
  • Giulia Rovesti Department of Oncology and Haematology, University Hospital of Modena, Italy
  • Margherita Rimini Department of Oncology and Haematology, University Hospital of Modena, Italy
  • Massimo Aglietta Department of Oncology, University of Turin, Torino, Italy; Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
  • Giovanni Brandi Department of Experimental, Diagnostic and Specialty Medicine, University Hospital S. Orsola-Malpighi, Bologna, Italy
  • Francesco Leone Division of Medical Oncology, ASL BI, Nuovo Ospedale degli Infermi, Ponderano, Italy

DOI:

https://doi.org/10.1080/0284186X.2021.1953704

Keywords:

Advanced biliary tract neoplasms, gallbladder neoplasms, cholangiocarcinoma, prognostic factors, prognostic score

Abstract

Background

Standard treatment of advanced biliary tract cancer (aBTC) is represented by first-line chemotherapy (CT1). However, some patients do not gain any benefit from CT1, contributing to the overall dismal prognosis of aBTC. The present study aimed to devise a prognostic model in aBTC patients receiving CT1.

Methods

A large panel of clinical, laboratory, and pathology variables, available before the start of CT1, were retrospectively assessed in a multi-centric cohort to determine their prognostic value on univariate and multivariate regression analysis. The variables that showed a significant correlation with overall survival (OS) were computed in a three-tier prognostic score. External validation of the prognostication performance was carried out.

Results

Clinical histories of 935 patients (median OS 10.3 months), with diagnosis dates ranging from 2001 to 2017, were retrieved from 14 institutions. According to multivariate analysis, Eastern Cooperative Oncology Group performance status, carbohydrate antigen 19.9, albumin levels, and neutrophil/lymphocyte ratio were strongly associated with OS (p <0.01). The prognostic score could generate a highly significant stratification (all between-group p values ≤0.001) into groups of favorable (comprising 51.5% of the sample), intermediate (39.2%), and poor prognosis (9.3%): median OS was 12.7 (CI95% 11.0–14.4), 7.1 (CI95% 5.8–8.4), and 3.2 months (CI95% 1.7–4.7), respectively. This OS gradient was replicated in the validation set (129 patients), with median OS of 12.7 (CI95% 11.0–14.3), 7.5 (CI95% 6.1–8.9), and 1.4 months (CI95% 0.1–2.7), respectively (all between-group p values ≤0.05).

Conclusion

A prognostic score, derived from a limited set of easily-retrievable variables, efficiently stratified a large population of unselected aBTC patients undergoing CT1. This tool could be useful to clinicians, to ascertain the potential benefit from CT1 at the start of treatment.

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Additional Files

Published

2021-10-03

How to Cite

Filippi, R., Montagnani, F., Lombardi, P., Fornaro, L., Aprile, G., Casadei-Gardini, A., … Leone, F. (2021). A prognostic model in patients with advanced biliary tract cancer receiving first-line chemotherapy. Acta Oncologica, 60(10), 1317–1324. https://doi.org/10.1080/0284186X.2021.1953704

Issue

Vol. 60 No. 10 (2021): Acta Oncologica

Section

Articles