The impact of biliary drainage on chemotherapy initiation and survival in patients with non-resected perihilar cholangiocarcinoma: a population-based study in the Netherlands

Perihilar cholangiocarcinoma (pCCA) is a rare malignancy originating from the bile duct bifurcation which is often diagnosed in an advanced stage. At presentation, most patients present with jaundice requiring biliary drainage. Palliative chemotherapy (pCTx) has a positive impact on survival and quality of life. The primary aim of this study was to investigate the impact of biliary drainage on pCTx initiation in patients with non-resected pCCA. Individual patient data from all Dutch patients diagnosed with non-resected pCCA between 2015 and 2020 were retrieved from the Netherlands Cancer Registry. Primary outcome were factors associated with initiation of pCTx, analysed by multivariable competing risk regression analysis. A total of 1265 patients were included, of whom 242 patients (19.1%) received pCTx after a median interval of 72 days [IQR 43–110 days] after initial presentation. Patients who underwent biliary drainage did not receive pCTx more often. If performed, drainage at a referral hospital (HR:0.65, 95%CI: 0.42–0.99), ≥3 drainage procedures performed (HR:0.53, 95%CI: 0.32–0.88), and drainage performed ≥14 days after presentation (HR:0.70, 95%CI: 0.49–0.99) were associated with no pCTx. Median overall survival for those who received pCTx and those who did not was 12.8 months [95%CI: 11.7–14.2] and 2.7 months [95%CI: 2.4–3.1]. The need for biliary drainage did not affect the initiation of pCTx. When indicated, biliary drainage should be performed as quick as possible in an academic center to improve the rate of patients receiving pCTx.