Ostwal Vikas, Pinninti Rakesh, Ramaswamy Anant, Shetty Nitin, Goel Mahesh, Patkar Shraddha, Mirani Jimmy, Nashikkar Chaitali, Banavali Shripad
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
Department of Radiology, Tata Memorial Hospital, Mumbai, India.
J Gastrointest Oncol. 2017 Apr;8(2):368-376. doi: 10.21037/jgo.2017.03.08.
Gemcitabine-Platinum doublet chemotherapy is the standard of care in patients with locally advanced inoperable and metastatic (LA/M) Gall bladder cancers (GBC).
Consecutive patients with LA/M GBC treated with Gemcitabine-Cisplatin (GC) or Gemcitabine-Oxaliplatin (GO) as first line palliative chemotherapy from January 2013 to June 2015 were retrospectively analysed. Patients who were able to continue chemotherapy beyond 6-8 cycles were separately compared to those who were potential candidates for this approach, but chose not to continue chemotherapy.
A total of 396 patients received first line palliative chemotherapy during the period of analysis, 276 patients (69.6%) were unable to complete 6-8 cycles of chemotherapy, while 120 patients (30.4%) were potential candidates for continuing chemotherapy. Seventy patients (n=120; 58.3%) received a median of 4 cycles of continuation chemotherapy. Median overall survival (OS) for the entire cohort was 7.65 months [95% confidence interval (CI), -7.14 to 8.16], while median event free survival (EFS) was 4.53 months (95% CI, -4.23 to 4.83). Patients receiving continuation chemotherapy had a statistically improved median OS compared to all other patient cohorts, 14.88 months (95% CI, -12.48 to 17.27; P=0.005 on multivariate analysis). Burden/number of sites of metastases, receiving of continuation chemotherapy, fit and able to receive second line chemotherapy (CT2) were identified on multivariate analysis as prognostic factors for OS.
OS in our study appeared lower than published literature, but a group of patients were identified whose survival could be prolonged by continuing chemotherapy. Easily available factors can predict prognosis of GBC undergoing first line palliative chemotherapy.
吉西他滨 - 铂类双联化疗是局部晚期不可切除及转移性（LA/M）胆囊癌（GBC）患者的标准治疗方案。
回顾性分析2013年1月至2015年6月期间接受吉西他滨 - 顺铂（GC）或吉西他滨 - 奥沙利铂（GO）作为一线姑息化疗的连续性LA/M GBC患者。将能够继续化疗超过6 - 8个周期的患者与那些有继续化疗可能但选择不继续化疗的患者进行单独比较。
在分析期间共有396例患者接受一线姑息化疗，276例患者（69.6%）无法完成6 - 8个周期的化疗，而120例患者（30.4%）有继续化疗的可能。70例患者（n = 120；58.3%）接受了中位4个周期的继续化疗。整个队列的中位总生存期（OS）为7.65个月[95%置信区间（CI），-7.14至8.16]，而中位无事件生存期（EFS）为4.53个月（95%CI，-4.23至4.83）。与所有其他患者队列相比，接受继续化疗的患者中位OS有统计学显著改善，为14.88个月（95%CI，-12.48至17.27；多因素分析P = 0.005）。多因素分析确定转移灶的负担/部位数量、接受继续化疗、身体状况适合并能够接受二线化疗（CT2）为OS的预后因素。
我们研究中的OS似乎低于已发表的文献，但确定了一组患者，其生存期可通过继续化疗延长。易于获得的因素可预测接受一线姑息化疗的GBC的预后。
