Real-world outcomes of first-line palliative treatments in advanced biliary tract cancer: A single-center experience from Thailand.

Abstract

119 Background: Biliary tract cancer (BTC) represents a significant health issue in Thailand, with many patients presenting with unresectable or metastatic disease. While gemcitabine-based chemotherapy is the standard first-line palliative treatment internationally, evidence from Thai clinical practice is limited. This study evaluated the overall survival of advanced BTC patients receiving first-line palliative chemotherapy in real-world settings. Methods: We conducted a retrospective study at Phramongkutklao Hospital, Thailand, including adult patients with unresectable BTC treated with first-line palliative chemotherapy from January 2018 to October 2025. Data were extracted from medical records. The primary endpoint was overall survival (OS), from diagnosis to death. Survival was estimated using the Kaplan–Meier method, and Cox regression was used to analyze OS associations with baseline variables. Results: 240 patients were included; median age, 63.5; 58.6% male. 44 (18.3%) received active first-line palliative chemotherapy. Intrahepatic cholangiocarcinoma was the most common tumor. Median overall survival was 7.0 months (95% CI, 6.0–11.0). One-year and two-year survival rates were 36.5% and 19.9%. Patients with active first-line chemotherapy showed significantly improved survival; median OS was 14.0 vs. 6.0 months (hazard ratio 0.62, 95% CI 0.41–0.94; p=0.025). No baseline factors were independently linked to OS. Conclusions: In this real-world Thai cohort, first-line palliative chemotherapy was associated with a meaningful improvement in overall survival among patients with advanced biliary tract cancer, though long-term outcomes remained poor. These findings provide context-specific real-world evidence to inform clinical decision-making and underscore the need for more effective therapeutic strategies in this high-burden setting. Baseline characteristics of the overall cohort (N = 240). Age at diagnosis, median (SD), years 63.5 (14.5) Male sex, No. (%) 140 (58.6) Primary tumor site, No. (%) Intrahepatic 124 (54.4); Distal extrahepatic 28 (12.3); Gallbladder 24 (10.5); Ampullary 35 (15.4); Other 29 (7.4) Metastatic disease at chemotherapy initiation, No. (%) 98 (43.6) Prior curative-intent surgery, No. (%) 11 (23.4) First-line palliative chemotherapy, No. (%) 44 (18.3) Gemcitabine + cisplatin 21 (47.6) Gemcitabine + oxaliplatin 9 (20.5) FOLFOX 9 (20.5) Other 5 (11.4) Abbreviations: BTC, biliary tract cancer; SD, standard deviation; IQR, interquartile range; WBC, white blood cell; ANC, absolute neutrophil count; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CEA, carcinoembryonic antigen; CA 19-9, carbohydrate antigen 19-9.