Department of Radiation Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
Int J Radiat Oncol Biol Phys. 2011 Sep 1;81(1):189-98. doi: 10.1016/j.ijrobp.2010.05.001. Epub 2010 Oct 23.
The benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic cholangiocarcinoma has not been clearly established. We analyzed survival outcomes of patients with resected extrahepatic cholangiocarcinoma and examined the effect of adjuvant RT.
Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2003. The primary endpoint was the overall survival time. Cox regression analysis was used to perform univariate and multivariate analyses of the following clinical variables: age, year of diagnosis, histologic grade, localized (Stage T1-T2) vs. regional (Stage T3 or greater and/or node positive) stage, gender, race, and the use of adjuvant RT after surgical resection.
The records for 2,332 patients were obtained. Patients with previous malignancy, distant disease, incomplete or conflicting records, atypical histologic features, and those treated with preoperative/intraoperative RT were excluded. Of the remaining 1,491 patients eligible for analysis, 473 (32%) had undergone adjuvant RT. After a median follow-up of 27 months (among surviving patients), the median overall survival time for the entire cohort was 20 months. Patients with localized and regional disease had a median survival time of 33 and 18 months, respectively (p<.001). The addition of adjuvant RT was not associated with an improvement in overall or cause-specific survival for patients with local or regional disease.
Patients with localized disease had significantly better overall survival than those with regional disease. Adjuvant RT was not associated with an improvement in long-term overall survival in patients with resected extrahepatic bile duct cancer. Key data, including margin status and the use of combined chemotherapy, was not available through the SEER database.
手术切除后辅助放疗（RT）对肝外胆管癌的益处尚未明确。我们分析了接受手术切除的肝外胆管癌患者的生存结果，并检查了辅助 RT 的效果。
数据来自 1973 年至 2003 年的监测、流行病学和最终结果（SEER）计划。主要终点是总生存时间。使用 Cox 回归分析对以下临床变量进行单变量和多变量分析：年龄、诊断年份、组织学分级、局限性（T1-T2 期）与区域性（T3 期或更高级别和/或淋巴结阳性）、性别、种族以及手术切除后是否使用辅助 RT。
获得了 2332 例患者的记录。排除了有先前恶性肿瘤、远处疾病、记录不完整或有冲突、非典型组织学特征以及接受术前/术中 RT 治疗的患者。在符合分析条件的 1491 例患者中，有 473 例（32%）接受了辅助 RT。在中位随访 27 个月（在存活患者中）后，整个队列的中位总生存时间为 20 个月。局限性和区域性疾病患者的中位生存时间分别为 33 个月和 18 个月（p<.001）。局部或区域性疾病患者的辅助 RT 并未改善整体或特定原因的生存。
局限性疾病患者的总体生存明显优于区域性疾病患者。辅助 RT 并不能改善接受手术切除的肝外胆管癌患者的长期总体生存。关键数据，包括切缘状态和联合化疗的使用，无法通过 SEER 数据库获得。
