Shinohara Eric T, Mitra Nandita, Guo Mengye, Metz James M
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
Int J Radiat Oncol Biol Phys. 2009 Jul 15;74(4):1191-8. doi: 10.1016/j.ijrobp.2008.09.017. Epub 2009 Feb 7.
Extrahepatic cholangiocarcinomas (EHC) are rare tumors of the biliary tree because of their low incidence, large randomized studies examining radiotherapy (RT) for EHC have not been performed. The purpose of this study was to examine the role of adjuvant and palliative RT in the treatment of EHC in a large patient population.
This was a retrospective analysis of 4,758 patients with EHC collected from the Surveillance, Epidemiology, and End Results database. The primary endpoint was overall survival.
Patients underwent surgery (28.8%), RT (10.0%), surgery and RT (14.7%), or no RT or surgery (46.4%). The median age of the patient population was 73 years (range, 23-104), 52.5% were men, and 80.7% were white. The median overall survival time was 16 months (95% confidence interval [CI] 15-17), 9 months (95% CI 9-11), 9 months (95% CI 9-10), and 4 months (95% CI 3-4) for surgery and RT, surgery, RT, and no RT or surgery, respectively. The overall survival was significantly different between the surgery and surgery and RT groups (p < .0001) and RT and no RT or surgery groups (p < .0001) on the log-rank test. The propensity score-adjusted analyses of surgery and RT vs. surgery (hazard ratio, 0.94; 95% CI, 0.84-1.05) were not significantly different, but that for RT vs. no RT or surgery (hazard ratio, 0.61; 95% CI, 0.54-0.70) was significantly different.
These results suggest that palliative RT prolongs survival in patients with EHC. The benefit associated with surgery and RT was significant on univariate analysis but not after controlling for potential confounders using the propensity score. Future studies should evaluate the addition of chemotherapy and biologic agents for the treatment of EHC.
肝外胆管癌（EHC）是胆管树的罕见肿瘤，由于其发病率低，尚未进行过针对EHC的大型随机放疗（RT）研究。本研究的目的是在大量患者群体中研究辅助性和姑息性放疗在EHC治疗中的作用。
这是一项对从监测、流行病学和最终结果数据库收集的4758例EHC患者的回顾性分析。主要终点是总生存期。
患者接受手术（28.8%）、放疗（10.0%）、手术加放疗（14.7%）或未接受放疗或手术（46.4%）。患者群体的中位年龄为73岁（范围23 - 104岁），52.5%为男性，80.7%为白人。手术加放疗、手术、放疗以及未接受放疗或手术患者的中位总生存时间分别为16个月（95%置信区间[CI] 15 - 17）、9个月（95% CI 9 - 11）、9个月（95% CI 9 - 10）和4个月（95% CI 3 - 4）。对数秩检验显示，手术加放疗组与手术组（p <.0001）以及放疗组与未接受放疗或手术组（p <.0001）的总生存期存在显著差异。手术加放疗与手术的倾向评分调整分析（风险比，0.94；95% CI，0.84 - 1.05）无显著差异，但放疗与未接受放疗或手术的倾向评分调整分析（风险比，0.61；95% CI，0.54 - 0.70）有显著差异。
这些结果表明，姑息性放疗可延长EHC患者的生存期。手术加放疗在单因素分析中有显著益处，但在使用倾向评分控制潜在混杂因素后则不然。未来的研究应评估化疗和生物制剂在EHC治疗中的添加效果。
