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Gómez-España MA, Montes AF, Garcia-Carbonero R, Mercadé TM, Maurel J, Martín AM, Pazo-Cid R, Vera R, Carrato A, Feliu J. SEOM clinical guidelines for pancreatic and biliary tract cancer (2020). Clin Transl Oncol 2021; 23:988-1000. [PMID: 33660222 PMCID: PMC8058005 DOI: 10.1007/s12094-021-02573-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/10/2022]
Abstract
Pancreatic cancer (PC) and biliary tract cancer (BTC) are both aggressive and highly fatal malignancies. Nowadays we have a profound knowledge about the molecular landscape of these neoplasms and this has allowed new therapeutic options. Surgery is the only potentially curative therapy in both cancers, but disease recurrence is frequent. In PC, adjuvant treatment with mFOLFIRINOX has improved overall survival (OS) and in BTC adjuvant treatment with capecitabine seems to improve OS and relapse-free survival. Concomitant radio-chemotherapy could also be considered following R1 surgery in both neoplasms. Neoadjuvant treatment represents the best option for achieving an R0 resection in borderline PC. Upfront systemic chemotherapy is the treatment of choice in unresectable locally advanced PC and BTC; then locoregional therapy could be considered after an initial period of at least 3-4 months of systemic chemotherapy. In metastatic PC, FOLFIRINOX or Gemcitabine plus nab-paclitaxel have improved OS compared with gemcitabine alone. In metastatic BTC, cisplatin plus gemcitabine constitute the standard treatment. Progress in the knowledge of molecular biology has enabled the identification of new targets for therapy with encouraging results that could in the future improve the survival and quality of life of patients with PC and BTC.
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Affiliation(s)
- Mª A. Gómez-España
- Medical Oncology Department, Hospital Universitario Reina Sofía, IMIBIC, CIBERONC, Córdoba, Spain
| | - A. F. Montes
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense (CHUO), Orense, Spain
| | - R. Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario, UCM, CNIO, CIBERONC, 12 de Octubre, IIS imas12, Madrid, Spain
| | - T. M. Mercadé
- Medical Oncology Department, Hospital Universitari Vall D´Hebron, Barcelona, Spain
| | - J. Maurel
- Medical Oncology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - A. M. Martín
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R. Pazo-Cid
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - R. Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - A. Carrato
- Medical Oncology Department, Hospital Universitario Ramón Y Cajal, Alcala University, IRYCIS, CIBERONC, Madrid, Spain
| | - J. Feliu
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC, IDIPAZ, Madrid, Spain
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Jackson SS, Van Dyke AL, Zhu B, Pfeiffer RM, Petrick JL, Adami HO, Albanes D, Andreotti G, Beane Freeman LE, Berrington de González A, Buring JE, Chan AT, Chen Y, Fraser GE, Freedman ND, Gao YT, Gapstur SM, Gaziano JM, Giles GG, Grant EJ, Grodstein F, Hartge P, Jenab M, Kitahara CM, Knutsen SF, Koh WP, Larsson SC, Lee IM, Liao LM, Luo J, McGee EE, Milne RL, Monroe KR, Neuhouser ML, O'Brien KM, Peters U, Poynter JN, Purdue MP, Robien K, Sandler DP, Sawada N, Schairer C, Sesso HD, Simon TG, Sinha R, Stolzenberg-Solomon RZ, Tsugane S, Wang R, Weiderpass E, Weinstein SJ, White E, Wolk A, Yuan JM, Zeleniuch-Jacquotte A, Zhang X, McGlynn KA, Campbell PT, Koshiol J. Anthropometric Risk Factors for Cancers of the Biliary Tract in the Biliary Tract Cancers Pooling Project. Cancer Res 2019; 79:3973-3982. [PMID: 31113819 PMCID: PMC6759233 DOI: 10.1158/0008-5472.can-19-0459] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/16/2019] [Accepted: 05/15/2019] [Indexed: 01/10/2023]
Abstract
Biliary tract cancers are rare but highly fatal with poorly understood etiology. Identifying potentially modifiable risk factors for these cancers is essential for prevention. Here we estimated the relationship between adiposity and cancer across the biliary tract, including cancers of the gallbladder (GBC), intrahepatic bile ducts (IHBDC), extrahepatic bile ducts (EHBDC), and the ampulla of Vater (AVC). We pooled data from 27 prospective cohorts with over 2.7 million adults. Adiposity was measured using baseline body mass index (BMI), waist circumference, hip circumference, waist-to-hip, and waist-to-height ratios. HRs and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards models adjusted for sex, education, race, smoking, and alcohol consumption with age as the time metric and the baseline hazard stratified by study. During 37,883,648 person-years of follow-up, 1,343 GBC cases, 1,194 EHBDC cases, 784 IHBDC cases, and 623 AVC cases occurred. For each 5 kg/m2 increase in BMI, there were risk increases for GBC (HR = 1.27; 95% CI, 1.19-1.36), IHBDC (HR = 1.32; 95% CI, 1.21-1.45), and EHBDC (HR = 1.13; 95% CI, 1.03-1.23), but not AVC (HR = 0.99; 95% CI, 0.88-1.11). Increasing waist circumference, hip circumference, waist-to-hip ratio, and waist-to-height ratio were associated with GBC and IHBDC but not EHBDC or AVC. These results indicate that adult adiposity is associated with an increased risk of biliary tract cancer, particularly GBC and IHBDC. Moreover, they provide evidence for recommending weight maintenance programs to reduce the risk of developing these cancers. SIGNIFICANCE: These findings identify a correlation between adiposity and biliary tract cancers, indicating that weight management programs may help minimize the risk of these diseases.
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Affiliation(s)
- Sarah S Jackson
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
| | - Alison L Van Dyke
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Bin Zhu
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Jessica L Petrick
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | | | | | | | - Julie E Buring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrew T Chan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yu Chen
- Department of Population Health and Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | - Gary E Fraser
- School of Public Health, Loma Linda University, Loma Linda, California
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc., Atlanta, Georgia
| | - J Michael Gaziano
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Boston Veteran Affairs Healthcare System, Boston, Massachusetts
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Eric J Grant
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Francine Grodstein
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Mazda Jenab
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Synnove F Knutsen
- School of Public Health, Loma Linda University, Loma Linda, California
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I-Min Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana
| | - Emma E McGee
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Kristine R Monroe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Marian L Neuhouser
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Ulrike Peters
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Jenny N Poynter
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Mark P Purdue
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Kim Robien
- Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | | | - Howard D Sesso
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tracey G Simon
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | | | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Renwei Wang
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Emily White
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jian-Min Yuan
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health and Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Peter T Campbell
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc., Atlanta, Georgia
| | - Jill Koshiol
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
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Van Dyke AL, Shiels MS, Jones GS, Pfeiffer RM, Petrick JL, Beebe-Dimmer JL, Koshiol J. Biliary tract cancer incidence and trends in the United States by demographic group, 1999-2013. Cancer 2019; 125:1489-1498. [PMID: 30645774 DOI: 10.1002/cncr.31942] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Biliary tract cancers (BTCs) are rare but deadly cancers (gallbladder cancer [GBC], intrahepatic cholangiocarcinoma [ICC], extrahepatic cholangiocarcinoma [ECC], and ampulla of Vater cancer [AVC]). A recent US study reported increasing GBC incidence among people younger than 45 years and blacks; however, it did not examine trends for other biliary tract sites. METHODS This study characterized demographic differences in BTC incidence rates and time trends by anatomic site. Population-based North American Association of Central Cancer Registries data were used to calculate age-adjusted incidence rates, incidence rate ratios (IRRs), and estimated annual percent changes (eAPCs) for 1999-2013 by site and demographic group. For sites with significant differences in eAPC by age group, IRRs were compared by age group. RESULTS GBC incidence rates declined among women (eAPC, -0.5%/y; P = .01) and all racial/ethnic groups except for non-Hispanic blacks, among whom rates increased (1.8%/y; P < .0001). Although GBC rates increased among 18- to 44-year-olds (eAPC, 1.8%/y; P = .01), they decreased among people 45 years old or older (-0.4%/y; P = .009). Sex (P < .0001) and racial/ethnic differences (P = .003 to .02) in GBC incidence were larger for younger people than older people. During this period, ICC (eAPC, 3.2%/y; P < .0001) and ECC rates (1.8%/y; P = .001) steadily increased across sex and racial/ethnic groups. Although AVC incidence rates increased among younger adults (eAPC, 1.8%/y; P = .03) but not older adults (-0.20%/y; P = .30), sex and racial/ethnic IRRs did not differ by age. CONCLUSIONS Differential patterns of BTC rates and temporal trends have been identified by anatomic site and demographic groups. These findings highlight the need for large pooling projects to evaluate BTC risk factors by anatomic site.
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Affiliation(s)
- Alison L Van Dyke
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Meredith S Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Gieira S Jones
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jessica L Petrick
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jennifer L Beebe-Dimmer
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Jill Koshiol
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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