Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China.
Department of Internal Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China.
Hepatobiliary Pancreat Dis Int. 2019 Apr;18(2):110-116. doi: 10.1016/j.hbpd.2018.11.001. Epub 2018 Nov 14.
The benefit of adjuvant chemotherapy for resectable cholangiocarcinoma remains unclear due to the lack of randomized control studies. This study aimed to investigate the possible benefit of postoperative adjuvant chemotherapy for resectable cholangiocarcinoma.
Relevant research articles published before 1st March 2018 in PubMed, Embase and the Cochrane library databases were retrieved. Published data were extracted and analyzed by RevMan 5.3, and the results were presented as hazard ratios (HRs) [95% confidence intervals (CI)] and forest plots.
One prospective and eighteen retrospective studies were included, with a total number of 11,458 patients, 4696 of whom received postoperative chemotherapy. There was a significant improvement of the overall survival (OS) for patients who underwent operation + adjuvant chemotherapy compared to those who underwent operation alone (HR = 0.61; P < 0.001). Subgroup analyses show that the postoperative chemotherapy group compared with operation alone group are indicated as follows: hilar cholangiocarcinoma group (HR = 0.60; P < 0.001), intrahepatic cholangiocarcinoma group (HR = 0.60; P < 0.001), R1 resection group (HR = 0.71; P = 0.04), LN-positive diagnosis group (HR = 0.58; P < 0.001), gemcitabine-based chemotherapy group (HR = 0.42; P < 0.001), distal cholangiocarcinoma group (HR = 0.48; P = 0.17), R0 resection group (HR = 0.69; P = 0.43), and 5-flurouracil-based chemotherapy group (HR = 0.90; P = 0.66), respectively.
Postoperative adjuvant chemotherapy can improve the OS in intrahepatic and hilar cholangiocarcinoma patients. However, distal cholangiocarcinoma patients gain no benefit from postoperative adjuvant chemotherapy. Prospective randomized trials are warranted in order to define the standard chemotherapy regimen.
由于缺乏随机对照研究，辅助化疗对可切除胆管癌的益处仍不清楚。本研究旨在探讨术后辅助化疗对可切除胆管癌的可能益处。
检索了 2018 年 3 月 1 日前在 PubMed、Embase 和 Cochrane 图书馆数据库中发表的相关研究文章。使用 RevMan 5.3 提取和分析已发表的数据，并以风险比（HR）[95%置信区间（CI）]和森林图呈现结果。
纳入了一项前瞻性研究和 18 项回顾性研究，共 11458 例患者，其中 4696 例接受了术后化疗。与单独手术相比，接受手术+辅助化疗的患者总生存率（OS）显著提高（HR=0.61；P<0.001）。亚组分析显示，术后化疗组与单纯手术组相比，如下结果具有统计学意义：肝门部胆管癌组（HR=0.60；P<0.001），肝内胆管癌组（HR=0.60；P<0.001），R1 切除组（HR=0.71；P=0.04），LN 阳性诊断组（HR=0.58；P<0.001），吉西他滨为基础的化疗组（HR=0.42；P<0.001），远端胆管癌组（HR=0.48；P=0.17），R0 切除组（HR=0.69；P=0.43）和 5-氟尿嘧啶为基础的化疗组（HR=0.90；P=0.66）。
术后辅助化疗可提高肝内和肝门部胆管癌患者的 OS。然而，远端胆管癌患者不能从术后辅助化疗中获益。需要前瞻性随机试验来确定标准的化疗方案。
