Amanda K Arrington, Rebecca L Wiatrek, Gagandeep Singh, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States.
World J Gastrointest Surg. 2013 Jun 27;5(6):178-86. doi: 10.4240/wjgs.v5.i6.178.
To examine surgical and medical outcomes for patients with cholangiocarcinoma using a population-based cancer registry.
Using the California Cancer Registry's Cancer Surveillance Program, patients with intrahepatic cholangiocarcinoma treated in Los Angeles County from 1988 to 2006 were identified and evaluated for clinical and pathologic factors and therapies received (surgery, radiation, and chemotherapy). The surgical cohort was further categorized into three treatment groups: patients who received adjuvant chemotherapy, adjuvant chemoradiation, or underwent surgery alone (no chemotherapy or radiation administered). Survival was assessed by Kaplan-Meier method; and Cox proportional hazard modeling was used in multivariate analysis.
Of 825 patients, 60.2% received no treatment. Of the remaining 328 patients, 18.5% chemotherapy only, 7.4% chemoradiation, and 13.8% underwent surgery. More male patients underwent surgical resection (P = 0.004). Surgical patients were younger than the patients receiving chemotherapy or chemoradiation (P < 0.001). Of the surgical cohort (n = 114), 60.5% underwent surgery alone while 39.5% underwent surgery plus adjuvant therapy (chemotherapy, n = 20; chemoradiation, n = 21) (P < 0.001). Median survival for all patients in the study was 6.6 mo. Median survival was highest for patients who underwent surgery (23 mo), whereas both chemotherapy (9 mo) and chemoradiation (8 mo) alone were each less effective (P < 0.001). By multivariate analysis, extent of disease, receipt of surgery, and administration of chemotherapy (with/without surgery) were independent predictors of overall survival.
This study demonstrates that surgery is a critical treatment modality. Multimodality treatment has yet to be standardized, but play a role in optimal therapy for cholangiocarcinoma.
利用基于人群的癌症登记系统，研究胆管癌患者的手术和医疗结果。
使用加利福尼亚癌症登记处的癌症监测计划，确定并评估了 1988 年至 2006 年在洛杉矶县接受治疗的肝内胆管癌患者的临床和病理因素以及接受的治疗（手术、放疗和化疗）。将手术组进一步分为三个治疗组：接受辅助化疗、辅助放化疗或仅手术（未给予化疗或放疗）的患者。通过 Kaplan-Meier 法评估生存情况；并在多变量分析中使用 Cox 比例风险模型。
在 825 名患者中，有 60.2％未接受治疗。在其余 328 名患者中，有 18.5％仅接受化疗，7.4％接受放化疗，13.8％接受手术。更多的男性患者接受了手术切除（P = 0.004）。手术患者比接受化疗或放化疗的患者年轻（P <0.001）。在手术组（n = 114）中，有 60.5％仅接受手术，而有 39.5％接受手术加辅助治疗（化疗，n = 20；放化疗，n = 21）（P <0.001）。研究中所有患者的中位生存期为 6.6 个月。接受手术的患者的中位生存期最高（23 个月），而单独化疗（9 个月）和单独放化疗（8 个月）的效果均较差（P <0.001）。通过多变量分析，疾病程度、接受手术和给予化疗（手术加/不加化疗）是总生存期的独立预测因素。
本研究表明手术是一种重要的治疗方式。多模式治疗尚未标准化，但在胆管癌的最佳治疗中发挥作用。
