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The impact of age and comorbidity in advanced or recurrent biliary tract cancer receiving palliative chemotherapy
Author(s) -
Takahara Naminatsu,
Nakai Yousuke,
Saito Kei,
Sasaki Takashi,
Suzuki Yukari,
Inokuma Akiyuki,
Oyama Hiroki,
Kanai Sachiko,
Suzuki Tatsunori,
Sato Tatsuya,
Hakuta Ryunosuke,
Ishigaki Kazunaga,
Saito Tomotaka,
Hamada Tsuyoshi,
Mizuno Suguru,
Kogure Hirofumi,
Tada Minoru,
Isayama Hiroyuki,
Koike Kazuhiko
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15066
Subject(s) - medicine , comorbidity , biliary tract cancer , chemotherapy , hazard ratio , performance status , neutropenia , gastroenterology , surgery , gemcitabine , confidence interval
Background and Aim Limited data are available on age and comorbidity assessment in patients with biliary tract cancer (BTC). This study aimed to evaluate the association of age and comorbidity burden with clinical outcomes of chemotherapy for BTC. Methods Consecutive 197 BTC patients undergoing first‐line chemotherapy between 2007 and 2017 were retrospectively studied. Patients were classified to three groups according to the age‐adjusted Charlson comorbidity index (ACCI) excluding the score about BTC and progression‐free survival, overall survival (OS), and safety were compared. Results Fifty‐one patients (26%) were elderly (≥ 75 years), and ACCI was 0–2 in 73 patients (37%), 3–4 in 98 (50%), and ≥ 5 in 26 (13%). ACCI was associated with the administration of first‐line combination chemotherapy (89% in 0–2, 80% in 3–4, and 64% in ≥ 5, P < 0.01) and second‐line chemotherapy (67% in 0–2, 51% in 3–4, and 35% in ≥ 5, P = 0.01). ACCI was prognostic for OS in addition to performance status, disease status, and CA19‐9: The hazard ratios in ACCI of 3–4 and ≥ 5 were 1.39 and 1.79, compared with ACCI of 0–2 ( P = 0.04). While overall safety profile did not differ by ACCI, higher ACCI score group developed Grade 3–4 neutropenia more frequently (26% in 0–2, 42% in 3–4, and 46% in ≥ 5, P = 0.04). Conclusion Age and comorbidity burden did affect OS and safety profile in BTC patients undergoing first‐line palliative chemotherapy. ACCI can be a simple and useful tool to evaluate the age and comorbidity burden in these patients.