Kim Yi-Jun, Kim Kyubo
Department of Radiation Oncology, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
Chin J Cancer. 2017 Oct 30;36(1):85. doi: 10.1186/s40880-017-0252-1.
Conditional survival (CS) has been established as a clinically relevant prognostic factor for cancer survivors, and the CS in gallbladder (GB) cancer has not yet been fully evaluated. In this study, we evaluated the cancer-specific CS rate and cancer-specific survival (CSS) rate in patients with GB cancer at multiple time points and investigated prognostic factors which affect cancer-specific CS rate to provide more accurate survival information.
Between 2004 and 2013, a total of 9760 patients with GB cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) data. The 3-year cancer-specific CS rate was calculated using the covariate-adjusted survival function in the Cox model for each year since diagnosis, and the results were analyzed together with the adjusted CSS rates at the same time points. Cox proportional hazards regression was performed to ascertain the individual contribution of factors associated with CSS rate at diagnosis and cancer-specific CS rates at 1, 3, and 5 years after diagnosis.
The adjusted 5-year CSS rate was 26.1%. The adjusted 3-year cancer-specific CS rates at 1, 2, 3, 4, and 5 years after diagnosis were 55.5, 72.2, 81.5, 86.8, and 90.5%, respectively. At the time of diagnosis, age, race, histology, grade, T, N, and M categories, surgery, radiotherapy, insurance status, and marriage status were significant prognostic factors of CSS. Five years after diagnosis, however, T and M categories were significant prognostic factors for survivors (P = 0.007 and P = 0.009, respectively), whereas surgery and radiotherapy were not.
T and M categories were significant prognostic factors even 5 years after the initial diagnosis, whereas local treatments at the time of diagnosis were not, suggesting that patients with GB cancer at high risks might need further adjuvant therapy after primary treatments. The combined analysis of CSS and cancer-specific CS rates offered more accurate survival information for patients who have already survived a certain period of time after diagnosis.
条件生存（CS）已被确立为癌症幸存者的一个临床相关预后因素，而胆囊（GB）癌的CS尚未得到充分评估。在本研究中，我们评估了GB癌患者在多个时间点的癌症特异性CS率和癌症特异性生存率（CSS），并调查了影响癌症特异性CS率的预后因素，以提供更准确的生存信息。
2004年至2013年间，从监测、流行病学和最终结果（SEER）数据中识别出9760例GB癌患者。使用Cox模型中的协变量调整生存函数计算自诊断以来每年的3年癌症特异性CS率，并将结果与同一时间点的调整后CSS率一起分析。进行Cox比例风险回归以确定诊断时与CSS率以及诊断后1、3和5年癌症特异性CS率相关因素的个体贡献。
调整后的5年CSS率为26.1%。诊断后1、2、3、4和5年的调整后3年癌症特异性CS率分别为55.5%、72.2%、81.5%、86.8%和90.5%。在诊断时，年龄、种族、组织学、分级、T、N和M分类、手术、放疗、保险状况和婚姻状况是CSS的显著预后因素。然而，诊断后5年，T和M分类是幸存者的显著预后因素（分别为P = 0.007和P = 0.009），而手术和放疗则不是。
即使在初次诊断后5年，T和M分类仍是显著的预后因素，而诊断时的局部治疗则不是，这表明高危GB癌患者在初次治疗后可能需要进一步的辅助治疗。CSS和癌症特异性CS率的联合分析为诊断后已存活一定时间的患者提供了更准确的生存信息。
