Yin Luxi, Xu Qi, Li Jingjing, Wei Qing, Ying Jieer
Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang.
State Key Laboratory of Molecular Oncology and Department of Etiology & Carcinogenesis, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medicine (Baltimore). 2018 Dec;97(50):e13570. doi: 10.1097/MD.0000000000013570.
Biliary tract cancer (BTC) patients have poor prognosis even following radical resection. To improve the current status, more evidence is required clarifying the role of adjuvant chemotherapy. This study aim is to evaluate the efficacy of adjuvant chemotherapy and discuss the regimen choices.We retrospectively analyzed the clinical data of 80 patients who underwent curative-intent R0 resection from 2008 to 2016. Among them, 40 patients had received adjuvant chemotherapy, and the others in the observation group were 1:1 matched by clinical characteristics including gender, age, tumor stage, and ECOG performance status score. Kaplan-Meier analysis was performed to compare DFS and OS. Potential confounding factors were adjusted by Multivariate analysis.In the entire patient cohort, the mean disease-free survival (DFS) time of BTC patients with adjuvant chemotherapy and observation was 18.63 ± 3.63 months versus 10.36 ± 1.67 months, respectively (P = .029). There was no significant difference observed in overall survival (OS) time (33.72 ± 5.02 vs 21.05 ± 4.12 months, P = .114). On multivariate analysis, adjuvant chemotherapy and N factor were found to be significant factors for DFS, and sex, age, T factor were found to be significant factors for OS. Besides, subgroup analysis indicated that combination chemotherapy prolonged DFS time of BTC patients than single-agent to some extent, and oral agents showed efficacy to improve OS.This retrospective study demonstrates that adjuvant chemotherapy contributes to DFS, but is unsatisfactory for improving OS. Combination chemotherapy contained oral agents provides a possibility of therapeutic strategy for improving surgical outcomes of BTC patients.
即使接受根治性切除,胆管癌(BTC)患者的预后仍较差。为改善现状,需要更多证据来阐明辅助化疗的作用。本研究旨在评估辅助化疗的疗效并探讨方案选择。我们回顾性分析了2008年至2016年接受根治性R0切除的80例患者的临床资料。其中,40例患者接受了辅助化疗,观察组的其他患者根据性别、年龄、肿瘤分期和美国东部肿瘤协作组(ECOG)体能状态评分等临床特征进行1:1匹配。采用Kaplan-Meier分析比较无病生存期(DFS)和总生存期(OS)。通过多变量分析调整潜在的混杂因素。在整个患者队列中,接受辅助化疗和观察组的BTC患者的平均无病生存时间分别为18.63±3.63个月和10.36±1.67个月(P = 0.029)。总生存时间未观察到显著差异(33.72±5.02对21.05±4.12个月,P = 0.114)。多变量分析显示,辅助化疗和N因素是DFS的显著因素,性别、年龄、T因素是OS的显著因素。此外,亚组分析表明,联合化疗在一定程度上比单药化疗延长了BTC患者的DFS时间,口服药物显示出改善OS的疗效。这项回顾性研究表明,辅助化疗有助于DFS,但对改善OS并不理想。含口服药物的联合化疗为改善BTC患者手术结局提供了一种治疗策略的可能性。