a Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC , University of Amsterdam , Amsterdam , the Netherlands.
b Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC , University of Amsterdam , Amsterdam , the Netherlands.
Acta Oncol. 2019 Jul;58(7):1048-1055. doi: 10.1080/0284186X.2019.1590634. Epub 2019 Mar 25.
Population-based data on distal cholangiocarcinoma (DCC) from the Western world are not available, albeit essential to identify areas for improvement. This study investigated the incidence, treatment and outcomes, including time trends and predictors for survival, in a nationwide cohort of DCC. This is a retrospective cohort study of patients diagnosed with DCC (2009-2016) derived from the Netherlands Cancer Registry. Overall survival (OS) and its predictors were analyzed using Kaplan-Meier and Cox regression analysis. Time trends (2009-2012 versus 2013-2016) were assessed. Overall, 1338 patients with DCC were included, with 1-, 3- and 5-year OS of 46%, 18%, and 11%. Incidence of DCC was 0.55-0.90 per 100.000 per year. Median OS was 10.4 months across all stages; 21.9 months for resected ( = 620, 46.3%), 6.7 months for unresected nonmetastatic ( = 445, 33.3%), and 3.6 months for metastatic DCC ( = 273, 20.4%) ( < .001). After resection, 30-day mortality was 4.8% and 90-day mortality 7.7%. Patients with metastatic DCC who received chemotherapy (n = 78, 28.6%) had a median OS of 8.2 versus 2.8 months for those not treated ( < .001). Over time, resection rates (53.6% to 61.7%, = .008) and use of palliative chemotherapy in metastatic DCC (22.3% to 32.9%, = .05) increased, without improvement in OS (10.3 vs 10.6 months, = .55). Independent poor prognostic factors for OS in resected disease were increasing age, pT3/T4 stage, higher lymph node ratio, poor differentiation, and R1 resection. In a nationwide cohort of DCC, resection rates and the use of chemotherapy increased whereas OS remained stable at 10.4 months.
基于人群的西方远端胆管癌（DCC）数据尚不可用，尽管这些数据对于确定需要改进的领域至关重要。本研究通过全国性的 DCC 队列调查了该疾病的发病率、治疗方法和结果，包括时间趋势和生存预测因素。这是一项对荷兰癌症登记处（2009-2016 年）确诊的 DCC 患者进行的回顾性队列研究。使用 Kaplan-Meier 和 Cox 回归分析评估了总体生存率（OS）及其预测因素。评估了时间趋势（2009-2012 年与 2013-2016 年）。共纳入了 1338 例 DCC 患者，其 1、3 和 5 年 OS 率分别为 46%、18%和 11%。DCC 的发病率为每年每 100000 人 0.55-0.90 人。所有阶段的中位 OS 为 10.4 个月；可切除（ = 620 例，46.3%）为 21.9 个月，不可切除非转移性（ = 445 例，33.3%）为 6.7 个月，转移性 DCC（ = 273 例，20.4%）为 3.6 个月（ < .001）。切除后 30 天死亡率为 4.8%，90 天死亡率为 7.7%。接受化疗的转移性 DCC 患者（n = 78，28.6%）的中位 OS 为 8.2 个月，而未接受化疗的患者为 2.8 个月（ < .001）。随着时间的推移，切除率（从 53.6%增加到 61.7%， = .008）和转移性 DCC 中姑息性化疗的使用（从 22.3%增加到 32.9%， = .05）有所增加，但 OS 没有改善（10.3 对 10.6 个月， = .55）。可切除疾病中 OS 的独立预后不良因素包括年龄增加、pT3/T4 期、较高的淋巴结比例、分化差和 R1 切除。在全国性的 DCC 队列中，切除率和化疗的使用有所增加，而 OS 仍稳定在 10.4 个月。
