肝内胆管细胞癌患者接受切除术的辅助治疗和生存预测因素。
Predictors of adjuvant treatment and survival in patients with intrahepatic cholangiocarcinoma who undergo resection.
机构信息
Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Newton Wellesley Hospital, Newton, MA 02462, USA.
Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA.
出版信息
Am J Surg. 2019 Nov;218(5):959-966. doi: 10.1016/j.amjsurg.2019.02.036. Epub 2019 Mar 4.
BACKGROUND
Administration of adjuvant therapy (AT) in patients with intrahepatic cholangiocarcinoma (ICC) remains inconsistent despite recent trial data. This study investigates predictors of receipt of AT and survival.
METHODS
Patients with ICC who underwent resection were identified using the NCDB (2004-2014). Logistic regression and Cox analysis were used to determine predictors of AT and survival, respectively. "High-risk" was defined as positive margins/nodes or stage III/IVa disease.
RESULTS
2813 patients were identified, of whom 42.3% received AT. Patients with positive margins, positive nodes, and higher stage tended to receive AT (p < 0.001). Black patients and patients with Medicare/Medicaid were less likely to receive AT. In "high-risk" patients, AT was associated with lower mortality (HR 0.66, 95% CI 0.56-0.78, p < 0.001).
CONCLUSIONS
AT after ICC resection is associated with improved survival in patients with positive margins, positive nodes, and stage III/IVa disease. There are disparities and regional variations in the receipt of AT.
背景
尽管最近有试验数据，但在肝内胆管癌（ICC）患者中辅助治疗（AT）的应用仍不一致。本研究调查了接受 AT 和生存的预测因素。
方法
使用 NCDB（2004-2014 年）确定接受切除术的 ICC 患者。使用逻辑回归和 Cox 分析分别确定 AT 和生存的预测因素。“高危”定义为阳性边缘/节点或 III/IVa 期疾病。
结果
确定了 2813 名患者，其中 42.3%接受了 AT。边缘阳性、淋巴结阳性和较高分期的患者更有可能接受 AT（p<0.001）。黑人患者和拥有医疗保险/医疗补助的患者不太可能接受 AT。在“高危”患者中，AT 与死亡率降低相关（HR 0.66，95%CI 0.56-0.78，p<0.001）。
结论
ICC 切除术后接受 AT 与边缘阳性、淋巴结阳性和 III/IVa 期疾病患者的生存改善相关。接受 AT 存在差异和区域差异。
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