{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T19:13:16Z","timestamp":1767985996011,"version":"3.49.0"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,8,25]],"date-time":"2017-08-25T00:00:00Z","timestamp":1503619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Lymph node metastasis is a poor prognostic factor for biliary tract cancers (BTCs). The optimal management of patients who have BTC with positive regional lymph nodes, including the impact of surgery and adjuvant therapy (AT), is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This was a retrospective cohort study of patients who had T1\u2010T3N1M0 gallbladder cancer (GBC) and intrahepatic cholangiocarcinoma (IHC) in the National Cancer Database (2004\u20102012). Patients were classified by treatment approach (nonoperative, surgery, surgery plus AT). Associations between the overall risk of death and treatment strategy were evaluated with multivariable Cox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Rates of surgical resection were 84.1% for patients with GBC (n = 1335) and 36.6% for those with IHC (n = 1009). The median overall survival of patients in the nonoperative, surgery, and surgery plus AT group was 11.6, 13.3, and 19.6 months, respectively, for those with GBC (log\u2010rank <jats:italic>P<\/jats:italic> &lt; .001), and 12.7, 16.2, and 22.6 months, respectively, for those with IHC (log\u2010rank <jats:italic>P<\/jats:italic> &lt; .001), respectively. Compared with nonoperative therapy, surgery with or without AT was associated with a lower risk of death from GBC (surgery with AT: hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.48\u20100.73; surgery without AT: HR, 0.71; 95% CI, 0.56\u20100.89) and from IHC (surgery with AT: HR, 0.52; 95% CI, 0.42\u20100.63; surgery without AT: HR, 0.70; 95% CI, 0.56\u20100.87). AT that included radiation was associated with a lower risk of death relative to surgery alone for patients with GBC regardless of margin status (margin\u2010negative resection: HR, 0.66; 95% CI, 0.52\u20100.84; margin\u2010positive resection: HR, 0.54; 95% CI, 0.39\u20100.75), but adjuvant chemotherapy alone was not. For patients with IHC, no survival benefit was detected with adjuvant chemotherapy or radiation for those who underwent either margin\u2010positive or margin\u2010negative resection.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The best outcomes for patients who have lymph node\u2013positive BTCs are associated with margin\u2010negative resection and, in those who have GBC, the inclusion of adjuvant chemotherapy with radiation regardless of margin status. <jats:bold><jats:italic>Cancer<\/jats:italic> 2018;124:74\u201083<\/jats:bold>. \u00a9 <jats:italic>2017 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.30968","type":"journal-article","created":{"date-parts":[[2017,8,25]],"date-time":"2017-08-25T10:32:38Z","timestamp":1503657158000},"page":"74-83","source":"Crossref","is-referenced-by-count":65,"title":["The role of surgery and adjuvant therapy in lymph node\u2013positive cancers of the gallbladder and intrahepatic bile ducts"],"prefix":"10.1002","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8612-8272","authenticated-orcid":false,"given":"Hop S.","family":"Tran Cao","sequence":"first","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianzi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3196-2398","authenticated-orcid":false,"given":"Yvonne H.","family":"Sada","sequence":"additional","affiliation":[{"name":"Department of Medicine Baylor College of Medicine Houston Texas"},{"name":"Veterans Affairs Health Services Research and Development Center for Innovations in Quality Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christy","family":"Chai","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9533-2769","authenticated-orcid":false,"given":"Steven A.","family":"Curley","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nader N.","family":"Massarweh","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas"},{"name":"Veterans Affairs Health Services Research and Development Center for Innovations in Quality Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,8,25]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"National Comprehensive Cancer Network (NCCN).NCCN Hepatobiliary Cancers Guidelines. Available at:https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/hepatobiliary.pdf. Accessed May 5 2017."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/hpb.12444"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-015-2922-0"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2015.07.006"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199611000-00008"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(97)00269-9"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0007-1323.2001.01879.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","DOI":"10.1200\/JCO.2017.35.15_suppl.4006","article-title":"Adjuvant capecitabine for biliary tract cancer: the BILCAP randomized study [abstract]","volume":"35","author":"Primrose JN","year":"2017","journal-title":"J Clin Oncol."},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10831"},{"issue":"4","key":"e_1_2_8_11_1","article-title":"Gemox versus surveillance following surgery of localized biliary tract cancer: results of the PRODIGE 12\u2010ACCORD 18 (UNICANCER GI) phase III trial [abstract]","volume":"35","author":"Edeline J","year":"2017","journal-title":"J Clin Oncol."},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-015-1498-0"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.957951"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.21141"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11699"},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1177\/000313480106700905","article-title":"Location, not staging, of cholangiocarcinoma determines the role for adjuvant chemoradiation therapy","volume":"67","author":"Serafini FM","year":"2001","journal-title":"Am Surg."},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.03.018"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.40.5381"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.5137"},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"djw202","DOI":"10.1093\/jnci\/djw202","article-title":"Adjuvant therapy for resected gallbladder cancer: analysis of the National Cancer Database [serial online]","volume":"109","author":"Mantripragada KC","year":"2016","journal-title":"J Natl Cancer Inst."},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.20831"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.33.8020"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-4501-8"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.60.2219"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0908721"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.30968","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.30968","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T17:18:30Z","timestamp":1760289510000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.30968"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,25]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1002\/cncr.30968"],"URL":"https:\/\/doi.org\/10.1002\/cncr.30968","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,25]]}}}