Fuller Clifton D, Wang Samuel J, Choi Mehee, Czito Brian G, Cornell John, Welzel Tania M, McGlynn Katherine A, Luh Join Y, Thomas Charles R
Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
Cancer. 2009 Nov 15;115(22):5175-83. doi: 10.1002/cncr.24572.
Although surgical resection is the mainstay of treatment for extrahepatic cholangiocarcinoma, the majority of patients present with advanced disease. Due in part to numeric rarity, the optimum role of radiotherapy (RT) for extrahepatic cholangiocarcinoma, as well as its relative benefit, is an area of debate. The specific aim of this series was to estimate survival for extrahepatic cholangiocarcinoma patients receiving surgery and adjuvant RT using a robust population-based data set.
Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) limited-use data set for selected extrahepatic cholangiocarcinoma cases. Lognormal multivariate survival analysis was implemented to estimate survival for patients for treatment cohorts based on extent of surgical intervention and RT.
Parametric estimated median survival for patients receiving total/radical resection + RT was 26 months; it was 25 months for total/radical resection alone, 25 months for subtotal/debulking resection + RT, 21 months for subtotal/debulking resection, 12 months for RT alone, and 9 months for those not receiving surgery or RT. Parametric multivariate analysis revealed age, American Joint Committee on Cancer Stage, grade, and surgical/radiation regimen as statistically significant covariates with survival. Surgery alone and adjuvant RT cohorts demonstrated evidence of improved survival compared with no treatment; comparatively, RT alone was associated with survival decrement. Early improvement in survival in adjuvant cohorts was not observed at later time points.
Survival estimates using SEER data suggest an early survival advantage for adjuvant RT for patients with locoregional extrahepatic cholangiocarcinoma. Although future prospective series are needed to confirm these observations, SEER data represent the largest domestic population-based extrahepatic cholangiocarcinoma cohort, and may provide useful baseline survival estimates for future studies.
尽管手术切除是肝外胆管癌的主要治疗方法，但大多数患者就诊时已处于疾病晚期。部分由于病例数量稀少，放射治疗（RT）在肝外胆管癌中的最佳作用及其相对益处仍是一个有争议的领域。本系列研究的具体目的是使用一个强大的基于人群的数据集，估计接受手术和辅助放疗的肝外胆管癌患者的生存率。
从监测、流行病学和最终结果（SEER）有限使用数据集中提取选定的肝外胆管癌病例数据。采用对数正态多变量生存分析，根据手术干预程度和放疗情况估计各治疗队列患者的生存率。
接受全/根治性切除+放疗患者的参数估计中位生存期为26个月；单纯全/根治性切除为25个月，次全/减瘤切除+放疗为25个月，次全/减瘤切除为21个月，单纯放疗为12个月，未接受手术或放疗者为9个月。参数多变量分析显示，年龄、美国癌症联合委员会分期、分级以及手术/放疗方案是与生存相关的统计学显著协变量。与未治疗相比，单纯手术和辅助放疗队列显示出生存改善的证据；相比之下，单纯放疗与生存下降相关。在后期时间点未观察到辅助治疗队列的生存早期改善情况。
使用SEER数据进行的生存估计表明，辅助放疗对局部区域性肝外胆管癌患者有早期生存优势。尽管需要未来的前瞻性研究来证实这些观察结果，但SEER数据代表了国内最大的基于人群的肝外胆管癌队列，可能为未来研究提供有用的基线生存估计。
