Real-life analysis of treatment approaches and the role of inflammatory markers on survival in patients with advanced biliary tract cancer

Abstract

Objectives

Advanced-stage biliary tract cancers (BTC) are rare malignancies with poor prognosis. There are few prospective trials, but several retrospective studies regarding treatment options. In this study, we aimed to investigate the role of systemic inflammatory parameters (SIP) and other possible independent factors that may affect survival and treatment approaches and to determine the benefit of later-line treatments in these patients.

Methods

A total of 284 patients, initially diagnosed with advanced stage or progressed after curative treatment of BTC, from different oncology centers in Turkey were included in this retrospective study. The prognostic significance of clinicopathological factors, SIPs and treatment options was analyzed.

Results

At a median follow-up of 13 months, the median progression-free survival (PFS) was 6.1 months (95% CI:5.51–6.82), and the median overall survival (OS) time was 16.8 months (95% CI: 13.9–19.6). Treatment choice (p < .001 HR:0.70 CI95% 0.55–0.9), performance status (p < .001 HR:2.74 CI 95% 2.12–3.54) and neutrophil-to-lymphocyte ratio (NLR) (p = .02 HR:1.38 CI 95% 1.03–1.84) were independent prognostic factors for PFS. For OS, the independent prognostic indicators were determined as The Eastern Cooperative Oncology Group Performance Status (ECOG PS) (p < .001 HR:1.78 CI 95% 1.5–2.3), Systemic Immune-inflammation Index (SII) (p < .001 HR:0.51 CI95% 0.36–0.73) and stage at diagnosis (p = .002 HR:1.79 CI 95% 1.24–2.59). Furthermore, second and third line treatments significantly prolonged OS in advanced BTC (p < .001 HR:0.55 CI 95% 0.38–0.79; p = .007 HR:0.51 CI95% 0.31–0.83, respectively).

Conclusion

SII and NLR are useful prognostic factors and may be helpful in making treatment decisions. Additionally, second and later-line treatments in advanced BTC have a significant impact on survival under real-life conditions.

Keywords:

• Biliary tract cancer
• NLR
• SII
• second-line chemotherapy
• best supportive care

Transparency

Declaration of funding

This paper was not funded.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors read and gave their stamp of approval for the submission of the final version of the manuscript.

Ethics statement

Written informed consent was obtained from all participants. The Local Ethics Committee of Istanbul Medipol University approved the study in June 2021 with decision number E-10840098-772.02-2913.

Data availability statement

The data that support the findings of this study are not openly available. Further inquiries can be directed to the corresponding author.