Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2010 Jul 15;77(4):1186-90. doi: 10.1016/j.ijrobp.2009.06.033. Epub 2009 Dec 4.
To analyze the outcome of adjuvant chemoradiotherapy for patients with distal common bile duct (CBD) cancer who underwent curative surgery, and to identify the prognostic factors for these patients.
Between January 1991 and December 2002, 38 patients with adenocarcinoma of the distal CBD underwent curative resection followed by adjuvant chemoradiotherapy. There were 27 men and 11 women, and the median age was 60 years (range, 34-73). Adjuvant radiotherapy was delivered to the tumor bed and regional lymph nodes up to 40 Gy at 2 Gy/fraction with a 2-week planned rest. Intravenous 5-fluorouracil (500 mg/m(2)/day) was given on day 1 to day 3 of each split course. The median follow-up period was 39 months.
The 5-year overall survival rate of all patients was 49.1%. On univariate analysis, only histologic differentiation (p = 0.0005) was associated with overall survival. Tumor size (< or =2 cm vs. >2 cm) had a marginally significant impact on the treatment outcome (p = 0.0624). However, there was no difference in overall survival rates between T3 and T4 tumors (p = 0.6189), for which the main determinants were pancreatic and duodenal invasion, respectively. On multivariate analysis, histologic differentiation (p = 0.0092) and tumor size (p = 0.0046) were independent risk factors for overall survival.
Long-term survival can be expected in patients with distal CBD cancer undergoing curative surgery and adjuvant chemoradiotherapy. Histologic differentiation and tumor size were significant prognostic factors predicting overall survival, whereas duodenal invasion was not. This finding suggests the need for further refinement in tumor staging.
分析接受根治性手术的远端胆总管（CBD）癌患者辅助化疗放疗的结果，并确定这些患者的预后因素。
1991 年 1 月至 2002 年 12 月期间，38 例远端 CBD 腺癌患者接受了根治性切除术，随后接受了辅助化疗放疗。其中 27 例为男性，11 例为女性，中位年龄为 60 岁（范围 34-73 岁）。辅助放疗采用 2 周计划休息的方式，在 40 Gy 时采用 2 Gy/分次的方式施予肿瘤床和区域淋巴结。在每个分割疗程的第 1 至 3 天静脉注射 5-氟尿嘧啶（500mg/m²/天）。中位随访期为 39 个月。
所有患者的 5 年总生存率为 49.1%。单因素分析表明，仅组织学分化（p=0.0005）与总生存率相关。肿瘤大小（≤2cm 与>2cm）对治疗结果有一定影响（p=0.0624）。然而，T3 和 T4 肿瘤的总生存率无差异（p=0.6189），其主要决定因素分别为胰腺和十二指肠侵犯。多因素分析表明，组织学分化（p=0.0092）和肿瘤大小（p=0.0046）是总生存率的独立危险因素。
接受根治性手术和辅助化疗放疗的远端 CBD 癌患者可获得长期生存。组织学分化和肿瘤大小是预测总生存率的重要预后因素，而十二指肠侵犯则不是。这一发现表明需要进一步完善肿瘤分期。
