Increased multimodality treatment options has improved survival for Hepatocellular carcinoma but poor survival for biliary tract cancers remains unchanged

E Alabraba; H Joshi; N Bird; R Griffin; R Sturgess; N Stern; C Sieberhagen; T Cross; A Camenzuli; R Davis; J Evans; E O'Grady; D Palmer; R Diaz-Nieto; S Fenwick; G Poston; H Malik

doi:10.1016/j.ejso.2019.04.002

Increased multimodality treatment options has improved survival for Hepatocellular carcinoma but poor survival for biliary tract cancers remains unchanged

Eur J Surg Oncol. 2019 Sep;45(9):1660-1667. doi: 10.1016/j.ejso.2019.04.002. Epub 2019 Apr 9.

Authors

E Alabraba¹, H Joshi², N Bird², R Griffin³, R Sturgess⁴, N Stern⁴, C Sieberhagen⁴, T Cross⁵, A Camenzuli⁶, R Davis⁶, J Evans⁷, E O'Grady⁶, D Palmer⁸, R Diaz-Nieto², S Fenwick², G Poston², H Malik²

Affiliations

¹ Department of Hepato-Biliary Surgery, University Hospital Aintree, Liverpool, UK. Electronic address: edward.alabraba@nuh.nhs.uk.
² Department of Hepato-Biliary Surgery, University Hospital Aintree, Liverpool, UK.
³ Liverpool Clinical and Cancer Research UK Trials Unit, University of Liverpool, Liverpool, UK.
⁴ Department of Hepato-Biliary Medicine, University Hospital Aintree, Liverpool, UK.
⁵ Department of Hepato-Biliary Medicine, Royal Liverpool Hospital, Liverpool, UK.
⁶ Department of Radiology, University Hospital Aintree, Liverpool, UK.
⁷ Department of Radiology, Royal Liverpool Hospital, Liverpool, UK.
⁸ Oncology Department, Clatterbridge Hospital, Bebington, UK.

PMID: 31014988
DOI: 10.1016/j.ejso.2019.04.002

Abstract

Background: Primary hepatobiliary cancer incidence in the UK is rising and survival rates are low. Surgery is the main curative option for these cancers, but multimodality therapies are expanding. The aim of our original study was to determine trends in survival, over an 8-year period, of patients treated for primary hepatobiliary cancers at our tertiary referral Centre.

Method: Patients treated for the most common types of primary hepatobiliary cancers, namely Hepatocellular carcinoma (HCC), Cholangiocarcinoma and Gallbladder cancer between January 2009 and December 2016 were retrospectively analysed from a prospective database linked to UK Hospital Episode Statistics data.

Results: A total of 1536 patients with primary hepatobiliary cancers were assessed and treatment plans formulated at our supra-regional specialist Hepatobiliary MDT. The primary hepatobiliary cancers treated were HCC (n = 836), Cholangiocarcinoma (n = 516), and Gallbladder cancer (n = 184). Survival for all the 3 cancers was significantly better with curative treatment. Overall median survival times were 350, 180, and 150 days respectively for HCC, Cholangiocarcinoma and Gallbladder cancer. Excluding best supportive care patients, the respective survival figures were 900, 600, and 400 days. Survival for HCC patients improved over time and was significantly increased in the final 3 years of the study (p ≤ 0.011 for all). Cholangiocarcinoma and Gallbladder cancer survivals were poor and did not change significantly over time.

Conclusion: HCC outcome has improved in association with expanded multimodal therapies. Survivals for cholangiocarcinoma and gallbladder cancer remain poor in parallel with limited expansion of multimodal therapies highlighting an unmet therapeutic need for biliary tract cancers.

Keywords: Cholangiocarcinoma; Gallbladder cancer; HCC; Hepatocoellular carcinoma; MDT; Primary liver cancers.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Biliary Tract Neoplasms / mortality*
Biliary Tract Neoplasms / therapy*
Carcinoma, Hepatocellular / mortality*
Carcinoma, Hepatocellular / therapy*
Combined Modality Therapy
Female
Humans
Liver Neoplasms / mortality*
Liver Neoplasms / therapy*
Male
Middle Aged
Registries
Retrospective Studies
Survival Rate
United Kingdom