Early Recurrence Limits Post-recurrence Therapy in Biliary Tract Cancer: A Rationale for Neoadjuvant Chemotherapy
In brief
In high-risk biliary cancer, preoperative chemotherapy linked to 43% lower death hazard
In this retrospective study, high-risk patients who received chemotherapy before surgery had a 43% lower hazard of death and a 39% lower hazard of recurrence than those who had surgery first. High risk meant lymph nodes appeared involved or CA19-9 was at least 200 U/mL; recurrence within a year was linked to difficulty continuing treatment. The findings need confirmation in prospective studies.
- Journal
- Annals of surgical oncology (Q1)
- Published
- 9 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Daisaku Yamada, Hirofumi Akita, Yosuke Mukai, Kazuki Sasaki, Shinichiro Hasegawa, Yoshito Tomimaru, et al.
- PMID
- 42853501
- DOI
- 10.1245/s10434-026-20524-4
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 12 October 2026): Neoadjuvant chemotherapy rationale for resectable biliary tract cancer with early
Abstract
BACKGROUND: The optimal treatment strategy for resectable biliary tract cancer (BTC) remains controversial, particularly in patients at high risk of early recurrence. We aimed to identify preoperative risk factors associated with impaired feasibility of post-recurrence treatment and to evaluate the impact of neoadjuvant chemotherapy (NAC) in high-risk patients. PATIENTS AND METHODS: We retrospectively analyzed patients with BTC who underwent upfront surgery (n = 323). Risk factors for intolerance (inability to continue systemic therapy for ≥ 3 months) after recurrence were evaluated, and high-risk patients were defined based on preoperative factors. In a separate cohort of 171 high-risk patients, outcomes were compared between patients who received NAC (n = 49) and those who underwent upfront surgery. RESULTS: In the cohort of upfront surgery, clinical lymph node positivity (HR 1.96, P < 0.001) and elevated carbohydrate antigen 19-9 (CA19-9) levels (≥ 200 U/mL; HR 1.84, P < 0.001) were independent risk factors for recurrence-free survival (RFS). Among patients who developed recurrence, recurrence within 1 year was independently associated with intolerance after recurrence (OR 0.37, P = 0.003). Clinical lymph node positivity and/or elevated CA19-9 levels were independent risk factors for recurrence within 1 year (OR 3.27, P = 0.027). In the high-risk cohort, NAC was associated with significantly improved overall survival (OS) and RFS compared with upfront surgery (OS: HR 0.57, P = 0.022; RFS: HR 0.61, P = 0.016). CONCLUSIONS: Patients with resectable BTC with elevated CA19-9 or clinical lymph node positivity are at high risk of early recurrence and limited treatment feasibility after recurrence. NAC may improve outcomes in this population by delaying recurrence.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.