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Five-Year Follow-Up of the Phase III ASCOT Trial of Adjuvant S-1 After Resection for Biliary Tract Cancer.

Created on 24 Sep 2026

Authors

Masafumi Ikeda, Kohei Nakachi, Masaru Konishi, Riku Kajikawa, Hiroshi Katayama, Yusuke Sano, Teiichi Sugiura, Sohei Satoi, Masaaki Murakawa, Akira Tomokuni, Satoshi Nara, Yu Takahashi, Ken-Ichi Okada, Naoki Hama, Keiko Kamei, Ken Kamata, Seiji Natsume, Takuji Okusaka, Junji Furuse, Makoto Ueno

Published in

Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Pages JCO2600017. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

The ASCOT phase III trial demonstrated that adjuvant S-1, an oral fluoropyrimidine, improved 3-year overall survival (OS) from 67.6% to 77.1% in patients with resected biliary tract cancer (BTC). We report the prespecified final 5-year follow-up analysis. In this multicenter, open-label, randomized trial conducted in Japan, 440 patients with resected BTC were assigned to observation (n = 222) or S-1 (n = 218). S-1 (40 mg/m2 twice daily, 4 weeks on/2 weeks off, for four cycles) was orally administered. The primary end point was OS in the intention-to-treat population. At a median follow-up of 61.5 months, the 5-year OS was 64% in the S-1 arm and 52% in the observation arm (hazard ratio [HR], 0.72 [95% CI, 0.55 to 0.95]; one-sided P = .01). The median OS was 8.2 years with S-1 and 5.9 years with observation. The median relapse-free survival was 3.5 versus 6.1 years (observation v S-1); unstratified and stratified (by primary tumor site and lymph node status) HRs were 0.80 (95% CI, 0.62 to 1.03) and 0.76 (95% CI, 0.59 to 0.98), respectively. Treatment effects were generally consistent across subgroups. These findings confirm a sustained survival benefit with adjuvant S-1 and support its role as a standard treatment for resected BTC.

PMID:
42777180
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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