Kim Yi-Jun, Kim Kyubo, Min Seog Ki, Nam Eun Mi
1 Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
2 Department of Surgery, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
Br J Radiol. 2017 Mar;90(1071):20160807. doi: 10.1259/bjr.20160807. Epub 2017 Feb 15.
To evaluate the benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic bile duct (EHBD) cancer.
From 1997 to 2015, 59 patients with EHBD cancer were the subject of this study; 36 patients not undergoing adjuvant treatment after surgery (observation group) and 23 patients receiving adjuvant RT (RT group) were compared. Microscopic residual disease (R1) was in 9 (25%) patients and 5 (22%) patients, and macroscopic residual disease (R2) was in 2 (6%) patients and 6 (26%) patients in the observation and RT groups, respectively. Adjuvant RT was delivered to the tumour bed and regional lymph nodes up to 50.4 Gy (range, 45-61 Gy).
With a median follow-up of 19 months, local recurrence was observed in 10 (28%) patients and 2 (9%) patients in the observation and RT groups, respectively. On univariate analysis, the 5-year local recurrence-free survival (LRFS) rates were 50% in the observation group and 54% in the RT group (p = 0.401). The 5-year overall survival (OS) rates were 29.3% in the observation group and 26.3% in the RT group (p = 0.602). On multivariable analysis, however, adjuvant RT significantly improved LRFS [hazard ratio (HR), 0.310; 95% confidence interval (CI), 0.100-0.963; p = 0.043] and had a trend towards increased OS (HR, 0.491; 95% CI, 0.219-1.102; p = 0.085). Resection margin (RM) status was also correlated with LRFS (HR for R1 6.134, 95% CI 2.051-18.344; and HR for R2 18.551, 95% CI 3.680-93.520; p < 0.001) and OS (HR for R1 1.816, 95% CI 0.853-3.867; and HR for R2 3.564, 95% CI 1.175-10.809; p = 0.054).
RM status was a significant prognosticator of EHBD cancer, and adjuvant RT improved local control rate; thereby, survival rate might be increased. Advances in knowledge: The benefit of adjuvant RT in EHBD cancer was demonstrated via comparison with observation group.
评估肝外胆管（EHBD）癌手术切除后辅助放疗（RT）的益处。
1997年至2015年，本研究纳入59例EHBD癌患者；比较36例术后未接受辅助治疗的患者（观察组）和23例接受辅助RT的患者（RT组）。观察组和RT组分别有9例（25%）和5例（22%）患者存在显微镜下残留病灶（R1），分别有2例（6%）和6例（26%）患者存在肉眼可见残留病灶（R2）。辅助RT照射肿瘤床及区域淋巴结，剂量达50.4 Gy（范围45 - 61 Gy）。
中位随访19个月，观察组和RT组分别有10例（28%）和2例（9%）患者出现局部复发。单因素分析显示，观察组5年局部无复发生存率（LRFS）为50%，RT组为54%（p = 0.401）。观察组5年总生存率（OS）为29.3%，RT组为26.3%（p = 0.602）。然而，多因素分析显示，辅助RT显著改善了LRFS [风险比（HR），0.310；95%置信区间（CI），0.100 - 0.963；p = 0.043]，且有提高OS的趋势（HR，0.491；95% CI，0.219 - 1.102；p = 0.085）。切缘（RM）状态也与LRFS（R1的HR为6.134，95% CI为2.051 - 18.344；R2的HR为18.551，95% CI为3.680 - 93.520；p < 0.001）和OS（R1的HR为1.816，95% CI为0.853 - 3.867；R2的HR为3.564，95% CI为1.175 - 10.809；p = 0.054）相关。
RM状态是EHBD癌的重要预后指标，辅助RT可提高局部控制率，从而可能提高生存率。知识进展：通过与观察组比较，证明了辅助RT在EHBD癌中的益处。
